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The Coming Medical Ethics Crisis | Jeffrey A. Singer | Cato Institute: Commentary: "These protocols govern the therapeutic decisions made by the health care practitioner — right down to the pre-operative antibiotics a surgeon may order. Despite the fact that several recent peer-reviewed studies concluded that the protocols have had no positive effect — in fact, one study showed post-op skin infections increased since the protocols were instituted — CMS imposes financial penalties on hospitals that fail to get protocol compliance from their medical staff."
"One way CMS is trying to deal with this is by penalizing hospitals and doctors who treat patients with resistant problems. Effective this year, any patient readmitted to a hospital within 30 days of discharge for the same or a related problem will be treated by the hospital without compensation."
"In a few years, almost all doctors will be employees of hospitals and will be ordered to practice medicine according to federally prescribed guidelines — guidelines that put the best interests of the state ahead of the interests of individual patients.
When the physician's primary obligation is to satisfy the wishes of the payer — ultimately the wishes of the state — how can patients be truly confident in their doctors' decisions?"
Wednesday, April 04, 2012
What to Do on the Day after ObamaCare | John H. Cochrane | Cato Institute: Commentary
What to Do on the Day after ObamaCare | John H. Cochrane | Cato Institute: Commentary: "Insurance proper is what pays for unplanned large expenses, not for regular, predictable expenses. Insurance policies should be "guaranteed renewable": The policy should include a right to purchase insurance in the future, no matter if you get sick. And insurance should follow you from job to job, and if you move across state lines.
Why don't we have such markets? Because the government has regulated them out of existence."
"Start with the tax deduction employers can take for their contributions to group health-insurance policies — but which they cannot take for making contributions to employees for individual, portable insurance policies. This is why you have insurance only so long as you stay with one employer, and why you face pre-existing conditions exclusions if you change jobs.
Continue with the endless mandates (both state and federal) on insurance companies to provide all sorts of benefits people would otherwise not choose to buy. It sounds great to "make insurance companies pay" for acupuncture. But that raises the premiums, and then people choose not to buy the insurance. Instead of these mandates, at least allow people to buy insurance that only covers the big expenses."
"the expenses of emergency room treatment for indigent uninsured people are not health-care's central cost problem. Costs are rising because people who do have insurance, and their doctors, overuse health services and don't shop on price, and because regulations have salted insurance with ever more coverage for them to overuse."
"The number of new doctors is still restricted, thanks to Congress and the American Medical Association. Congress caps the number of residencies, the AMA has fought the expansion of medical schools, state tests make it difficult for foreign doctors to work here, and on and on.
There are hundreds of government impediments to competition. New hospitals? In my home state of Illinois, every new hospital, expansion of an existing facility or major equipment purchase must obtain a "certificate of need" from the Illinois Health Facilities Planning Board. The board does a great job of insulating existing hospitals from competition if they are well connected politically. Imagine the joy United Airlines would feel if Southwest had to get a "certificate of need" before moving in to a new city — or the pleasure Sears would have if Wal-Mart had to do so — and all it took was a small contribution to a well-connected official."
Why don't we have such markets? Because the government has regulated them out of existence."
"Start with the tax deduction employers can take for their contributions to group health-insurance policies — but which they cannot take for making contributions to employees for individual, portable insurance policies. This is why you have insurance only so long as you stay with one employer, and why you face pre-existing conditions exclusions if you change jobs.
Continue with the endless mandates (both state and federal) on insurance companies to provide all sorts of benefits people would otherwise not choose to buy. It sounds great to "make insurance companies pay" for acupuncture. But that raises the premiums, and then people choose not to buy the insurance. Instead of these mandates, at least allow people to buy insurance that only covers the big expenses."
"the expenses of emergency room treatment for indigent uninsured people are not health-care's central cost problem. Costs are rising because people who do have insurance, and their doctors, overuse health services and don't shop on price, and because regulations have salted insurance with ever more coverage for them to overuse."
"The number of new doctors is still restricted, thanks to Congress and the American Medical Association. Congress caps the number of residencies, the AMA has fought the expansion of medical schools, state tests make it difficult for foreign doctors to work here, and on and on.
There are hundreds of government impediments to competition. New hospitals? In my home state of Illinois, every new hospital, expansion of an existing facility or major equipment purchase must obtain a "certificate of need" from the Illinois Health Facilities Planning Board. The board does a great job of insulating existing hospitals from competition if they are well connected politically. Imagine the joy United Airlines would feel if Southwest had to get a "certificate of need" before moving in to a new city — or the pleasure Sears would have if Wal-Mart had to do so — and all it took was a small contribution to a well-connected official."
Minimum Wage, Including in N.J., Could Mean Maximum Damage | Alan Reynolds | Cato Institute: Commentary
Minimum Wage, Including in N.J., Could Mean Maximum Damage | Alan Reynolds | Cato Institute: Commentary: "The trouble is that most exempt jobs offer no training, no benefits and no future. Shrinking the number of jobs among larger, more visible employers by raising their minimum wage will result in trapping more unskilled young people in dead-end jobs where the law is not binding."
ObamaCare: The Supreme Court as a Constitutional Death Panel | Doug Bandow | Cato Institute: Commentary
ObamaCare: The Supreme Court as a Constitutional Death Panel | Doug Bandow | Cato Institute: Commentary: "For instance, New York Times columnist Paul Krugman complained that "the justices most hostile to the law don't understand, or choose not to understand, how insurance works." However, he doesn't appear to understand, or choose to understand, constitutional law. The issue is whether the Constitution grants the power asserted, not whether the legislation is good insurance policy."
"The Constitution consciously puts certain powers beyond the reach of even elected officials. If the Supreme Court effectively suspends or amends the Constitution by majority vote for whatever reason, there is no defensible rule of law."
"states otherwise have essentially unlimited power to tax and regulate. Which is why then-Massachusetts Gov. Mitt Romney could push into law a state requirement to buy health insurance."
"Then-House Speaker Nancy Pelosi (D-CA) responded "are you kidding" when asked about Congress' authority. Then-Majority Whip James Clyburn (D-SC) admitted that "There's nothing in the Constitution that says that the federal government has anything to do with most of the stuff we do." In their view Washington enjoys unlimited power. The Constitution is but a quaint ornament for display."
"The Constitution consciously puts certain powers beyond the reach of even elected officials. If the Supreme Court effectively suspends or amends the Constitution by majority vote for whatever reason, there is no defensible rule of law."
"states otherwise have essentially unlimited power to tax and regulate. Which is why then-Massachusetts Gov. Mitt Romney could push into law a state requirement to buy health insurance."
"Then-House Speaker Nancy Pelosi (D-CA) responded "are you kidding" when asked about Congress' authority. Then-Majority Whip James Clyburn (D-SC) admitted that "There's nothing in the Constitution that says that the federal government has anything to do with most of the stuff we do." In their view Washington enjoys unlimited power. The Constitution is but a quaint ornament for display."
Do Blood And Guts Make for Good Presidencies? | Gene Healy | Cato Institute: Commentary
Do Blood And Guts Make for Good Presidencies? | Gene Healy | Cato Institute: Commentary: '"military deaths as a percentage of population is a major determinant of greatness in the eyes of historians."'
'It's also worth reminding presidents that, as Wilson, Truman, and George W. Bush discovered, unnecessary wars make presidents unpopular. While historians may eventually award extra credit for spending American blood and treasure, ordinary Americans generally don't. Here again, they come out looking smarter than the intellectuals.'
'It's also worth reminding presidents that, as Wilson, Truman, and George W. Bush discovered, unnecessary wars make presidents unpopular. While historians may eventually award extra credit for spending American blood and treasure, ordinary Americans generally don't. Here again, they come out looking smarter than the intellectuals.'
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