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Thursday, March 31, 2005

Long-term care "Lone Ranger" Steve Moses

[Richard L. Peck, "Long-term care’s lone realist rides again," Nursing Homes/Long Term Care Management, March 2005.]

This is a great interview with Stephen Moses, President of the Center for Long-Term Care Financing. Moses has completed a thorough audit of Nebraska's long-term care system and has come to Kansas a number of times through Flint Hills to make the case for Medicaid reform:

Peck: Your Realist’s Guide offers a fascinating tour of the LTC planning approaches of several states, defining some that are close to “basket cases” and others that are closer to what might be described as “model” states. What are the patterns that seem to define them one way or another?

Moses: First of all, I wouldn’t use the term “model” states. They’re all basket cases to some degree or another, although it’s not entirely their fault. They’re hampered by various federal restrictions. But some are doing less well than others with the tools already at hand to ease their Medicaid burdens.

For example, California is still allowing a pyramid divestiture schedule—outlawed by OBRA ’93—that allows the wealthy to give away as much as $1 million in assets in a small fraction of the time allowed by federal law to qualify for Medi-Cal. Georgia, Michigan, and Texas have only just started implementing estate recoveries to reimburse their Medicaid programs for long-term care expenses. I predict that none of these three states will recover enough to pay for the estate recovery program itself because of the exclusions and exemptions they’ve built into their programs. Oregon has been doing estate recoveries since the inception of its Medicaid program, and today collects $15 for every $1 invested in running the program. In fact, it was the Oregon program that fi rst got me interested in this question when I was at HCFA in the early 1980s. I calculated back then how much the country as a whole would save in Medicaid expenditures if it did the same thing as Oregon and published the results for the Office of Inspector General. Since then it’s become even more clear that the potential to help support Medicaid for the poor and wake up baby boomers to their financial risks in relying on Medicaid is huge if and when Medicaid estate recoveries are pursued cost effectively.

This does not necessarily have to be a political problem, by the way, as some have called it. To get across the appropriateness of estate recovery, you show the public how the genuinely poor are hurt as they lose access to Medicaid-funded services, while the affluent just skate by.

Minnesota has a relatively strong estate recovery program and strict eligibility rules, along with a 10 to 14% penetration of long-term care insurance and active home equity conversion. Although its recent HCBS push has been counterproductive in the absence of stronger eligibility controls, it has a Medicaid nursing home census of only 59%. So it’s less a “basket case” than some others.

In general, the states do have options to make Medicaid eligibility more rational, and we need the federal government to give states more authority to do so. The market is heading in that direction. All I’m saying is, let’s expedite this and get the thing fixed before the whole system collapses.


[Stephen A. Moses, "Project Proposal: Controlling Medicaid Long-Term Care Costs," The Flint Hills Center, January 2004.]

Wednesday, March 30, 2005

New quality evaluation tool available to consumers

[P.J. Griekspoor, "Care, compared," The Wichita Eagle, 29 March 2005.]

A lack of information is often cited as a reason that consumers cannot be trusted to make their own health care decisions. Recent developments indicate that information is going to become much more readily available:

Wichita doctors and hospitals take quality measurement seriously.

That's the message that comes across as a new consumer Web site designed to report quality information goes online Friday.

Every hospital in Kansas will be listed on the Web site, which is a collaborative effort of the Centers for Medicare and Medicaid Services, national hospital organizations and other health care organizations.

The site has been in the works since November 2003. It is based on 17 standards related to care for heart attacks, congestive heart failure and pneumonia.

"We anticipate that more and more standards will be added as time goes on," said Joe Davison, president of the Medical Society of Sedgwick County. "We expect this to lead to a comprehensive look at how well our hospitals do in a whole range of areas."

The Centers for Medicare and Medicaid Services initiative, which began eight years ago with similar benchmarks for home health care and nursing homes, will assess doctors' offices within the next several months, Davison said.

"We're looking at a new way of practicing medicine," he said. "It's a new future."

Monday, March 28, 2005

HSA coverage improves in The Eagle

[Phyllis Jacobs Griekspoor, "Health accounts get noticed," The Wichita Eagle, 27 March 2005.]

Sunday's article in The Wichita Eagle represents a significant change in the coverage of Health Savings Accounts for the paper. An article on the 13th basically ruled them out and gave the impression that few were interested in the option, but the newer piece relies on statistical data rather than hearsay from insurance companies and the story is quite different:

High-deductible health insurance policies eligible for linking with tax-free savings accounts through a new federal program have attracted more families and low-income people than had been expected, a new study concludes.

Unfortunately, the tail end of the article reverts to downplaying the benefits:

Critics of the plan point to those numbers as evidence that HSA plans won't really work for the average family. With a savings of only $30 a month for a family or $12 for an individual, the premium reduction doesn't even begin to fund the savings account of $1,000 to $2,000 needed to meet the higher deductible, they point out.

And with no coverage of well-child checks, preventive medical exams, tests or prescription drugs until the deductible is met, they say it is unlikely that most people will actually have money left in savings to roll over, even if they fully fund their tax-free account.


While the "critics" are never named, presumably they are the same naysayers quoted in the previous piece. Their statements do not make any more sense this time around, either. For one thing, many employers are choosing to contribute to the accounts of their employees, and some insurance companies now offer "gap" riders that assist new enrollees in covering their deductible while they build up their balance. As well, many insurance companies do cover preventative care and other upfront costs. As the eHealthInsurance study reported on in the article shows, "99.4% of HSA-eligible plans purchased in 2004 included prescription drug benefits."

No one should expect that every news story become an advertisement for HSAs - objective coverage of any new development in health care should be the rule. But as additional proof of the benefits of HSAs surface, hopefully more news outlets will shift away from viewing HSAs as "yet another failure" right from the start.

[Dan Voorhis, "Big trend in health care: Health savings accounts debut in Wichita," The Wichita Eagle, 10 March 2005.]

Wednesday, March 16, 2005

Businesses developing HSA option for part-time employees

[Don Jacobson, "Uniprise, 50 big firms develop insurance option for part-timers," Business North, 13 March 2005.]


In an interesting development geared towards addressing the uninsured problem, a number of major companies are working together to offer their part-time employees lower-cost coverage than they could obtain on their own:

The perception of part-time work is changing. It used to mean after-school jobs for teenagers and college students looking to make some spending money. But working part-time is turning into a way of life for adults, one that may not be voluntary, and usually lacks health benefits.

In response, some Fortune 500 companies who employ millions of uninsured part-timers are trying to put a dent into that situation by pooling their buying power to offer affordable health coverage to those employees.

The new plan, called National Health Access, is being forwarded by Uniprise and 50 major companies including Sears, General Mills, IBM, General Electric and Caterpillar, as well as Parker-Hannifin.

Slated to start this fall, the program promises steep premium discounts for health insurance to part-timers through a pooling of the companies’ buying power.

Coordinated by the HR Policy Association, the professional organization of big-company human resources managers, the plan calls for no financial contribution from the employers other than a one-time $20,000 fee, so employees would pay for 100 percent of their premiums. But the rates they pay would be substantially lower than what they could find on the open market.

“This will be a ‘guaranteed-issue’ policy that will be aimed at low-income workers who might not be able to otherwise afford insurance, but you’d still get broad access to physicians in the UnitedHealth Care network. The higher-level plans have a health savings account feature. You’ve got 45 million uninsured people in America, and this is a good effort by employers coming together to do something about it,” [Marisa Milton, HR Policy Association’s Washington-based director of government relations] said.


[Matthew Hisrich, "HSAs are increasing Americans' health coverage," The Topeka Capital-Journal, 26 September 2004.]

Tuesday, March 15, 2005

Nuts and bolts of HSAs explained

[Kelly Greene, "Nuts and Bolts of HSAs," The Wall Street Journal, 13 March 2005.]

The Wall Street Journal continues its focus on Health Savings Accounts with this third installment in an ongoing series of articles that explain how HSAs work and how to go about obtaining one. This column features Roy Ramthun of the US Treasury, who will be presenting at a Flint Hills Center Workshop on HSAs in Wichita this April:

Many readers seem interested in opening health savings accounts -- but need help with the nuts and bolts.

One reader asked for clarification about how to deduct HSA contributions on tax returns. It's "literally a straight reduction from your income" that you enter in a new line on your tax form, says Roy Ranthum, senior adviser for health initiatives to the Treasury secretary in Washington. So, for example, if your taxable income would have been $40,000, and you contribute $5,000 to an HSA, your income on which you are taxed would fall to $35,000.

Can you transfer assets from an individual retirement account to an HSA without incurring taxes or penalties? Not under current federal law, Mr. Ranthum says. If you're at least 59½ years old, you could use an IRA distribution to fund an HSA, but you still would have to pay tax on the distribution.

Another reader asked if you can set up an HSA if you're unemployed and not yet on Medicare. The answer is yes. "Your employment status just doesn't matter," Mr. Ranthum says. "You don't even have to have earned income." Instead, you can take the deduction for HSA contributions against investment income.

It also doesn't matter whether you get the high-deductible insurance you need to qualify to open an HSA on your own or through a current employer or a former employer, "as long as you have it and don't have other coverage that disqualifies you," he adds.


["All About HSAs," U.S. Treasury Department, 18 August 2004.]

Woman with HSA finds out how hospital pricing really works - or doesn't

[Christopher Snowbeck, "The cost of a stitch, like all things medical, is not as clear as it seems," The Pittsburgh Post-Gazette, 13 March 2005.]

Patients are beginning the switch to consumer-driven plans and following through on the promise of those plans to create cost-conscious consumers. As this occurs, the media is increasingly likely to focus on the inability of health care providers to deliver prices based in some way on reality:

What's a fair price for a stitch?

It's a question that Michelle Boxer would like to answer, since the Ohio woman's two sons are becoming frequent visitors to emergency rooms.

Boxer's 5-year-old needed six stitches to the head in April after he vaulted a couch and landed on a coffee table. The total charges from a doctor and hospital in Dayton came to less than $100 per stitch.

Boxer's other son cut his hand on a broken cup during a visit to suburban Pittsburgh in July. Charges for hospital and physician care at UPMC Passavant Cranberry came to more than $400 per stitch.

"I just want them to explain it," said Boxer, who is contesting the UPMC bill. "I have a hard time paying something when it seems they're just trying to rip me off."

"The bottom line is that pricing for medical care, including emergency care, is a confusing mess," said Dr. Arthur Kellerman, chairman of the emergency medicine department at Emory University in Atlanta. "Come to think of it, the whole system is a mess."

Michelle Boxer is paying attention to her bills from UPMC Passavant Cranberry because the hospital was outside her health plan's network, meaning she is responsible for more than one-third of the charges. So she is scrutinizing her bills the way proponents of Health Savings Accounts might recommend.

Called HSAs for short, the accounts typically couple high deductible insurance policies that cover the cost of large health care bills with tax-free savings accounts from which individuals buy other medical services. They have been promoted by the Bush Administration as a solution to runaway health costs.

Greg Scandlen, director of the Galen Institute's Center for Consumer Driven Health Care in Washington, D.C., says the day of simplicity has already arrived in some places. There is a physician in Tennessee who does, in fact, charge by the stitch, Scandlen said.

Hospitals have been less enthusiastic about change, Scandlen said, but they might be forced to by class action lawsuits that have highlighted the high charges uninsured patients receive.

"I think we're entering a whole new world," he said.


[Greg Scandlen, "Choice is revolutionizing health care," The Flint Hills Center, 28 September 2004.]

Monday, March 14, 2005

Medicaid costs are a reason for, not an argument against TABOR

[George Dean, "TABOR is bad idea," The Wichita Eagle, 13 March 2005.]

Wichita regional AARP leader George Dean tries to pull a fast one in this op-ed on TABOR, basically saying that Kansas can't afford to have spending caps because we'll need to spend more money in the future.

States spend disproportionately on categories whose prices are rising fastest -- health care, education and corrections. The costs for these services are increasing much faster than the overall rate of inflation, so a formula that is based on overall inflation -- as every TABOR law is -- restricts needed services.

States also spend disproportionately on populations that cost more to serve and are growing faster than the average, especially seniors and people with disabilities. As the overall population grew by 15.4 percent between 1990 and 2002, the number of children with disabilities grew by 35 percent, and the number of elderly and people with disabilities on Medicaid grew by 70 percent. Over the next 35 years, the elderly population will grow at twice the rate of the general population.


The reality is that we cannot afford to keep spending like we are, and the demographics only make spending reform more urgent. The best line above is where Dean points out that state spending leads to more state spending. Health care, education and corrections are all areas that exist in a quasi-market state that is far more public than private. The former two certainly need not be that way, and the only way to restore sanity to the rising costs associated with these services is to force policymakers to recognize the need for change.

[Matthew Hisrich, "A Backgrounder on Kansas Medicaid," The Flint Hills Center, 19 July 2004.]

HSAs given a bad rap by big Kansas insurance companies

[Phyllis Jacobs Griekspoor, "Insurers' hikes slow," The Wichita Eagle, 13 March 2005.]

What a difference a couple of days make. After an excellent article from Dan Voorhis on the entry of financial institutions into the health savings account market last Thursday, this Phyllis Griekspoor article from Sunday is enough to leave a person speechless:

One product that does not seem to be catching on in the Wichita area is Health Savings Accounts, which pair a high-deductible insurance policy with a tax-free savings account. Bailey said Blue Cross is offering HSA products but has seen almost no interest in them.

"One reason is that people looking for an affordable product are not likely to have the money to fund a savings account or to pay a huge deductible," he said. "There are traditional products out there that offer pretty good premium rates. The premium differentials are just not enough to convince someone to make a move."

Clothier agreed.

He said most people can't afford a health savings account.

"The reality is all an HSA does is transfer the responsibility for payment to the employee, who really can't afford it," he said. "I don't think they are any solution to the health care crisis."


Not only are the claims outrageous, but no attempt is made to balance the views of major insurance companies, who obviously have nothing to gain from customers choosing a less-expensive coverage option.

Despite the views of these firms, the reality is that interest in HSAs has never been higher and the savings available are significant.

"This market is an emerging market off to a fast start," says America's Health Insurance Plans President Karen Ignani. In fact, a recent Hewitt Associates survey of more than 500 employers found that 57 percent are considering HSAs.

As Robert Harbison of Intrust Bank stated in the Voorhis article following the announcement of their HSA offering, “We're getting a lot of interest.”

The popularity of HSAs begins with a less-costly high-deductible health insurance policy that functions as true insurance rather than pre-paid health care. According to eHealthInsurance, 89 percent of HSA-eligible plan purchasers paid $200 or less per person per month, and 56 percent of HSA-eligible plan purchasers paid $100 or less per month.

Add to this a savings account that builds tax-free and follows individuals wherever they go, and the combination is quite powerful. A Watson Wyatt survey of nearly 1,000 individuals with health insurance found that 66 percent of respondents like the idea of having control of HSA funds, even after leaving their employer.

Traditional insurers may wish to keep this genie in the bottle, but the rest of the state is moving ahead no matter how much bad press they try to give HSAs. "This is not a little blip,” says William Short of UMB Bank, “this is the future of health care."

[Devon Herrick, "Health Savings Accounts: The Future Of Health Care For Kansans," The Flint Hills Center, 14 February 2005.]

Thursday, March 10, 2005

FDA seizure raises questions about reliability of imported drug delivery

[Maura Kelly Lannan, "FDA seizes prescription orders from I-SaveRX," Associated Press, The Lawrence Journal-World, 10 March 2005.]

While replacement prescriptions were quickly shipped to consumers this time, the recent seizure of medicine making a trip across the border does raise important questions for consumers and for the politicians who backed this plan:

The Food and Drug Administration has seized prescription drug orders sent from abroad to more than 50 customers of I-SaveRx, a multistate program to import cheaper prescription drugs from Europe and Canada.

The drugs, which were stopped at airports, included cholesterol lowering Lipitor and bone-strengthening Fosamax. Customers learned of the seizure through letters from the FDA, which said the drugs did not have the proper labeling or were not federally approved.

FDA Associate Commissioner William Hubbard denied that the agency, which opposes drug imports, stopped the shipments in an effort to shut down I-SaveRx. He said the agency has always seized high-risk drugs that can easily be counterfeit, such as Lipitor.

Gov. Rod Blagojevich launched I-SaveRx last year to help participants save money on prescription drugs. It uses a Canada-based clearinghouse, CanaRx, to connect residents of Illinois, Kansas, Missouri and Wisconsin to pharmacies and wholesalers in Canada, Ireland and the United Kingdom. The FDA opposes the importation, saying it can't ensure the safety of the drugs.


[Matthew Hisrich, "Sebelius Is Practicing Black-Market Politics," The Wichita Eagle, 10 December 2004.]

Wednesday, March 09, 2005

Dueling health plans

[Editorial, "Mesh proposals for health care," The Kansas City Star, 9 March 2005.
Scott Rothschild, "House kills governor's health care plan," The Lawrence Journal-World, 9 March 2005.]

The big news today is that one plan is gone and another has taken its place. Governor Sebelius's executive order to consolidate state government departments in health care was rejected by the House. As a replacement, the GOP has announced a similar consolidation effort:

On Tuesday legislative leaders finally came forth with a proposal that signaled a possible break in the gridlock. Their recommendation for a “Kansas Health Policy Authority” appears to incorporate many of the good ideas Sebelius and Praeger had proposed.

This all smacks of much ado about nothing much. While more efficient delivery of services through consolidation of agencies may yield some benefits, it is a move unlikely to stem rising health care costs and truly turn around programs such as Medicaid that are driving state spending through the roof. If the focus remains on reorganization going forward, then neither the Governor nor the legislature will have effectively addressed the state budget as a whole or health care in particular.

[Matthew Hisrich, "Kansas Needs Bold Medicaid Reform," The Wichita Eagle, 21 January 2004.]

Monday, March 07, 2005

Taking the mystery out of reverse mortgages

[Robert J. Bruss, "Pros and cons of tax-free senior citizen reverse mortgages," The Wichita Eagle, 6 March 2005.]

The Wichita Eagle ran a great overview of reverse mortgages for seniors over the weekend. Tapping into the financial power of these for long-term care could turn the nursing home market into a viable system once again and ultimately save Medicaid. People will need to be forced to exercise this option before receiving Medicaid assistance, however, for there is little incentive to whittle away your own assets if you have the option of spending someone else's instead:

What is a reverse mortgage? Exactly the opposite of a traditional home mortgage, which requires monthly payments from the borrower to the lender, a reverse mortgage creates payments flowing from the lender to the borrower.

- To be eligible, the house or condo owner must be 62 or older. To qualify for a senior citizen reverse mortgage, the property must be an owner-occupied single-family house, condominium or manufactured house on an owned lot.

- Only the residence is liable for eventual repayment of a reverse mortgage. There is never any personal liability for repayment even if the home decreases in market value or the total amount owed exceeds the home's value when the loan matures.

- Contrary to widespread myth, the reverse mortgage lender does not take title to the home.

Three major nationwide companies provide reverse mortgages:

- FHA has over 90 percent of the market. Their home equity conversion mortgage interest rate (HECM) is tied to the one-year Treasury Bill index, plus a margin.

- Fannie Mae "Home Keeper" reverse mortgages have a higher limit, currently almost $360,000 (higher in Hawaii and Alaska).

- Financial Freedom Plan reverse mortgages have no maximum limit. They appeal mostly to owners of homes worth more than $500,000. However, these reverse mortgages are not available in all states.

Use a calculator to compare reverse mortgages. The best way to compare reverse mortgages is to use an Internet calculator. I've found the best free calculator is at www.financialfreedom.com.

The major drawback of reverse mortgages is the senior citizen homeowners will be reducing their home equity as they receive payments in order to comfortably enjoy their retirement years.

The result is greedy prospective heirs of senior citizen homeowners often discourage obtaining a reverse mortgage, realizing that to do so reduces their inheritance. But heirs who care more about the homeowner than themselves encourage seniors who need additional income to obtain a reverse mortgage so they can live financially comfortable.


[Stephen A. Moses, "Project Proposal: Controlling Medicaid Long-Term Care Costs," The Flint Hills Center, January 2004.]

Door-to-door doctors

[Andrew Johnson, "The house call is back," The Washington Times, 6 March 2005.]

NCPA senior fellow and recent Flint Hills Center author Devon Herrick is quoted in this article on the emerging trend of doctors coming to see patients at home. As he explains, it is merely the market at work:

The number of physicians making house calls has grown steadily in the past three years to about 1,000, said Gresham Bayne, president of the American Academy of Home Care Physicians. The organization saw its own membership increase 15 percent last year.

The cause of the increase is the rapidly growing 80-and-older age demographic, Dr. Bayne said.

House calls aren't limited to primary care physicians anymore. Dentists, optometrists, veterinarians and podiatrists are shutting the doors to their offices and hitting the road.

Dr. Alan Dappen, owner of Doctor Family Medicine in Vienna, Va., makes house calls for patients within five miles of his office. The centerpiece of his practice, though, is a telephone and e-mail consultation service, which is billed according to time.

Patients can call or e-mail Dr. Dappen with medical questions before coming into the office. Often, a phone consultation will eliminate the need for an in-person visit, saving the patient money, he said.

The cost of a phone or e-mail consultation can range from $15 to more than $180, depending on how long they last.

Market demand is the driving factor behind house call and mobile practices, said Devon Herrick, a senior fellow at the National Center for Policy Analysis in Dallas. Consumers are becoming more aggressive about seeking health care, he said.

"Patients are driving a lot of this," said Mr. Herrick, author of the soon-to-be-released study "Consumer-Driven Health Care: The Changing Role of the Patient." "Doctors are responding to market forces."


[Devon Herrick, "Health Savings Accounts: The Future Of Health Care For Kansans," The Flint Hills Center, 14 February 2005.
Greg Scandlen, "Choice is revolutionizing health care," The Flint Hills Center, 28 September 2004.]

A storm for hospitals brews in Ohio

[Misti Crane and Geoff Dutton, "Nonprofit hospitals’ collection and charity policies under fire," The Columbus Dispatch, 6 March 2005.] (subscription required)

Greg Scandlen of The Galen Institute warned of intense media focus on hospitals almost every time he has spoken in Kansas, and if he is right then this new series from one of Ohio's major papers is probably just a preview of what will be coming around the country. The problem is that hospitals lack price transparency and inflate the prices they do eventually charge as a result of insurance company discounts and Medicaid and Medicare reimbursement policies. The result is that the uninsured - perhaps those least able to afford such high costs - are stuck paying the full bill. Increasingly, questions of ethics are beginning to arise, and some are even dragging hospitals into court:

Nationally, free care and unpaid patient bills have shrunk to the lowest levels in two decades as a percentage of total hospital costs, according to American Hospital Association statistics.

Hundreds of hospitals are facing lawsuits questioning their charity policies, taxing agencies in some communities are forcing hospitals to pay, and patient advocates are pushing for more generous charity policies

Although charity care covers most of the poor and uninsured, some patients who cannot pay their bills may find themselves in court.

Local hospitals sometimes charge interest, file liens on homes and garnish wages, inflating the bills and marring a patient’s credit for years.

Hospitals in Illinois, Indiana and Connecticut have gone as far as having uninsured patients thrown in jail for failing to appear in court to answer for unpaid bills. That never has happened here, say patient advocates and hospital administrators.

But in Columbus, as in other places, the uninsured routinely are charged far more than others for the same care and procedures.

The government and private insurance companies negotiate with hospitals for rates that are well below the posted fees. But when billing those who don’t have insurance, hospitals charge and try to collect the full amount.

It’s the medical equivalent of expecting the uninsured to pay the sticker price for a new car while everyone else bargains, sometimes paying half or less.

Friday, March 04, 2005

The perfect drug

[Gilbert Ross, "The Myth of Absolute Safety," National Review, 2 March 2005.]

Is it possible for the FDA to guarantee us perfectly safe medicine? American Council on Science and Health executive and medical director Gilbert Ross reminds us that we cannot expect miracles:

The quest for safety in our drug supply is an admirable one — to a point. But activists refuse to understand the most elementary concept of drug evaluation — indeed of science itself: There is no such thing as "absolute safety." All of life's activities come with a baseline of unavoidable risk. As a public-health educator and former clinician, I've seen many lives lost and much needless suffering faced as a result of excess caution in the quest for "total safety."

Currently, even a slight risk of adverse effects has become unacceptable. Even drugs long on the market, such as Advil, have come under assault. For those who espouse the precautionary principle, the FDA has been "asleep at the wheel," unleashing lethal drugs on an unsuspecting populace, and should be reined in.

I encourage the new commissioner to consider the damage done by undue delay. The desperate need for new, more powerful remedies — for cancer, AIDS, resistant infections, and other ailments with ineffective or toxic therapies — should hold sway over the fear of novel medicines. Some toxicity is the price we pay for a vibrant, innovative drug industry, which remains the most productive and safest in the world.

Take for example the COX-2 drugs: There is plenty of blame to go around for the current situation, including excessive blanket DTC marketing and poor patient selection by physicians. That said, physicians and patients the world over owe a serious debt of gratitude to the FDA panel that (surprisingly) spared these drugs. The American public should not lose their potentially huge benefits; if for no other reason, their likely efficacy in the chemoprevention of cancer should keep them on the market while further studies identify those groups whose risk-benefit profiles support effective use.

When it comes to choosing to take a risk by prescribing or taking a drug, the doctor and his or her patient should make the decision, not the FDA or activist groups.

Thursday, March 03, 2005


Expanding the borders of health insurance coverage


The Cato Institute recently held a forum on fostering affordable health insurance through the creation of a nationwide market. This event features Rep. John Shadegg (R-AZ), who has introduced a bill to this effect; Michael O'Grady, HHS, who is developing a plan on their end; and Tom Miller, Joint Economic Committee.
This event is now available for viewing online.


TABORs solve budget problems, they don't create them


Some opponents of a Taxpayer Bill of Rights for Kansas point to Colorado's current budget difficulties as a reason not to enact one here. Confronted with the question of just what exactly could be behind their state's budget shortfall,
The Independence Institute responds with the following bumper sticker:


Urban-Brookings Tax Policy Center: U.S. is "way in excess of the government controlling more than one half of the [health care] market"

[Gail Russell Chaddock, "Medicaid: the 'monster in the road'," The Christian Science Monitor, 3 March 2005.]

This is an excellent companion piece to the article below on Europe's search for privatization ideas in the U.S. Government spending on health care is rising relative to private spending, and if changes aren't made we will follow down the same path Europeans are now trying to return from:

Launched in 1965 to provide healthcare for low-income women and children, Medicaid has since expanded into the largest health and long-term care program - a symbol of the increasing role of government in paying the nation's health bills.

While private funding covered some 75 percent of health costs in 1965, public funding is expected to count for half of national health spending by 2014, according to the Centers for Medicaid and Medicare Services. Some experts say that threshold has already been reached.

In addition to its own spending, government also pays the nation's health bill by the subsidies it offers for health-related expenses in the tax code, now approaching $200 billion. When you add in the subsidies, "you're way in excess of the government controlling more than one half of the market," said Eugene Steuerle, co-director of the Urban-Brookings Tax Policy Center at a recent briefing.

Medicaid enrollment has jumped 40 percent in the last five years, at a time when state revenues were dropping. For the first time, Medicaid now tops education as the leading draw on state budgets.


[Michael Bond and Matthew Hisrich, "Medicaid Lessons From Former Communists," The Wichita Independent Business Association Newsletter, February 2005.]

Europeans fed up with socialized medicine

[Rebecca Goldsmith, "Europe: Shopping for health care," The Seattle Times, 10 February 2005.]

There is an old joke about Marxists that says they all left the Soviet Union and are now working in American universities. The idea that Americans have a fondness for the failed experiments of Europe seems to have renewed relevance in light of calls for universal health coverage:

Europeans once lived and died by their national health plans.

In exchange for steep taxes, they received a lifetime of free or low-cost medical care. They expected doctors to diagnose their ailments, drugs to make them feel better and hospitals to perform necessary procedures.

But this once-sacred social pact is starting to break down. Fed up with long waits and worried about the quality of medical care, more European patients are losing faith in government-run health systems. Informed by the Internet and motivated by cheaper travel, many now seek medical care abroad and buy private health insurance.

After scouring the world for answers, some of Europe's top health officials believe they have found salvation for socialized medicine in an unusual place: the United States and other countries where capitalism guides health care.

The experiments promise to release patients from a government monopoly and improve care through competition. The outcome could make or break national budgets — and ultimately determine whether socialized medicine survives.

The changes in Europe contrast with what is happening in the United States, where people are looking to government to address soaring medical costs and the 43 million people who have no health insurance.

"The government can guarantee you universal coverage. What the government can't guarantee you is the care that you want when you want it," said Robert Moffit, director of the Center for Health Policy Studies, part of the Heritage Foundation, a conservative think tank in Washington, D.C.


[Charles W. Van Way, III, M.D., "The Strength of a Really Bad Idea," The Flint Hills Center, 8 May 2004.]

Tuesday, March 01, 2005

Governor Sebelius earns a D

["Grading the Governors," NCPA Daily Policy Digest, 1 March 2005.]

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Governor Sebelius did not fare well in a new report from The Cato Institute:

Researchers Stephen Moore and Stephen Slivinski find that the top-ranked governors have learned the dual lesson that you can't tax your way to recovery and that the best way out of a deficit is to cut spending.

According to the Cato report:

Former insurance commissioner Kathleen Sebelius ran as a fiscal moderate during her campaign for governor against incumbent Republican Bill Graves. She promised a top-to-bottom review of state government, but she refused to pledge to veto tax increases although she claimed not to favor tax hikes. Before Sebelius was inaugurated, she suggested that tax hikes would be on the horizon.

In November 2004 she set the stage for a battle over health care funding by proposing a 50-cent per pack increase in the cigarette tax. Sebelius’s expensive proposals so far are much different from the fiscal moderation she promised.

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