Posts tagged with: Affordable Care Act

ben carsonIn 2012, Dr. Ben Carson, former head of pediatric surgery at John Hopkins Hospital, rose to media attention at the National Prayer Breakfast in Washington, D.C. During that speech, he told the audience, including President and Mrs. Obama, that he didn’t mean to offend anyone, but he wasn’t going to be “politically correct,” either. Since then, Dr. Carson has been a regular contributor to The Daily Caller. He recently spoke in Sikeston, Missouri, and gave his prescription for what ails America.

Of all that’s ailing America, including the decline of education, Obamacare, politicians run amok, and government spending, the doctor offered various prescriptions. The Founders, [Carson] said, knew that the country relied on an informed populace. We must not be misled by “slick politicians and a dishonest media.” If we will “spend a half hour learning something new every single day … [we] become a formidable friend of truth and a formidable enemy of deception.” (more…)

Blog author: ehilton
posted by on Wednesday, February 5, 2014

lets-break-upDr. Kristin Held, a Texas physician, wrote a “Dear John” letter to Aetna, one insurance provider under which she works that now mandates Obamacare. Held believes patients will suffer under the new health care law.

You see, health insurance has evolved such that insurers and government have inserted themselves smack-dab in the middle of the once sacred patient-doctor relationship. I am called a provider- not a doctor. My patient is now yours- not mine. What I can do as a physician now has strangulating strings and nonsensical numbers attached- to you and government and money-not the best interests of the patients. (more…)

A new study by Grand Valley State University professors Leslie Muller and Paul Isely suggests that the Affordable Care Act has already cost West Michigan 1000 jobs. Muller summarized the results in a Wood TV story:

“Firms are actually holding off on hiring or their reducing their hiring that they were thinking they were going to be doing because of the ACA,” said Muller.

The 1,000 jobs lost does not include the number of workers in West Michigan that have lost hours to ensure that they are kept as part-time employees. Nearly one-third of companies said they have cut employees’ hours.

“We’re talking about a thousand jobs in West Michigan that would have been here absent the ACA,” Muller said.

The study found lower-skilled jobs tend to be suffering the most.

(more…)

In my blog post yesterday about our statist healthcare system and the need for more economic freedom, I referenced a NYT piece by Scott Gottleib and Zeke Emmanuel and argued that if their rosy view of America’s healthcare future has any chance of coming true, we’ll need far more economic freedom in the system than currently exists. Now Greg Scandlen has a sobering essay at the Federalist challenging the NYT piece, taking particular issue with their pointing to Massachusetts as a hopeful model and for suggesting that nurse practitioners will help make up the difference once Obamacare starts driving up demand for healthcare services.

Gottleib’s and Emmanuel’s argument had other elements, including a call for increased economic freedom for the healthcare industry, but on the Massachusetts point, Scandlen’s response appears devastating. In a nutshell, he notes that Massachusetts passed Obamacare-style reforms beginning seven years ago and now has much longer appointment waiting times than the rest of the country, despite having far more physicians per capita than the national average. Read the piece and the helpful data tables here.

In today’s Acton Commentary I explore how our hyper-regulated and increasingly statist healthcare system is chasing off good physicians.

A recent article in Forbes by Bruce Japsen provides some additional support for that argument:

Doctor and nurse vacancies are approaching nearly 20 percent at hospitals as these facilities prepare to be inundated by millions of patients who have the ability to pay for medical care thanks to the Affordable Care Act.

A survey by health care provider staffing firm AMN Healthcare shows the vacancy rate for physicians at hospitals near 18 percent in 2013 while the nurse vacancy rate is 17 percent. That vacancy rate is more than three times what it was just four years ago when vacancies for nurses were just 5.5 percent in 2009 while vacancies for doctors were 10.7 percent.

It’s not all doom and gloom. In an earlier Forbes piece, Scott Gottlieb, an internist and fellow at the American Enterprise Institute, argues that technological and organizational innovation will allow quality health care to be delivered using fewer physicians.

If allowed to proceed, these innovations may actually increase market freedom in one area. Physician organizations and medical schools often have replicated a pernicious feature of the traditional guild, namely, finding ways to limit the number of new physicians not purely as a quality control measure but, beyond this, as a way to ensure that existing physicians are in high demand. (more…)

Stamp-higher-educationThe latest topic of The City podcast is the higher education bubble, featuring Cate MacDonald, Dr. John Mark Reynolds, and Dr. Holly Ordway. Reynolds makes the point that bubbles can arise when things are overvalued, but that it is important to determine whether that thing is relatively overvalued or absolutely overvalued. That is, to speak of a higher education bubble is to recognize that higher education is relatively more expensive than it is worth, but that it isn’t therefore worth nothing. The challenges facing higher education are various and multi-faceted, and one of the key issues is the necessity of determining how college education ought to be valued.

The podcast also discusses the level of student indebtedness, which is perhaps a sign of the disconnect between cost and value, and this also is a topic that comes up in the recent controversy in the latest issue of the Journal of Markets & Morality between William Pannapacker and Marc Baer of Hope College. The point of departure for the discussion is the question, “Should students be encouraged to pursue graduate education in the humanities?” Pannapacker has a long-running column in the Chronicle of Higher Education under the pen name Thomas H. Benton that has addressed issues of graduate higher education and academic culture. In a 2009 piece, “Graduate School in the Humanities: Just Don’t Go,” Pannapacker writes,

It can be painful, but it is better that undergraduates considering graduate school in the humanities should know the truth now, instead of when they are 30 and unemployed, or worse, working as adjuncts at less than the minimum wage under the misguided belief that more teaching experience and more glowing recommendations will somehow open the door to a real position.

The adjunct phenomenon also features prominently in the JMM controversy between Pannapacker and Baer. As Baer contends, “Adjunct is a different problem in which academic leaders are more victims than perpetrators. The real perpetrator, at least for public universities, is the state legislator who has so unthinkingly starved higher education of resources.”

Moving from the state to the federal level, one possible consequence of the Affordable Care Act is that graduates who rely on adjunct teaching to make a living may face a greater squeeze on their already questionable financial livelihoods. As Mark Peters and Douglas Belkin report in The Wall Street Journal, “The federal health-care overhaul is prompting some colleges and universities to cut the hours of adjunct professors” because of the potential costs of providing health coverage to those adjuncts who teach 30 hours per week or more.

The first two pieces from the controversy are available for free on the JMM site: William Pannapacker’s “Should Students Be Encouraged to Pursue Graduate Education in the Humanities?” and Marc Baer’s “‘Graduate Education in the Humanities’: A Response to William Pannapacker.” The concluding pieces of the controversy are available to current subscribers, and you can become one today.

The Affordable Care Act, more commonly known as “Obamacare”, is a strange law from the perspective of economic theories of insurance markets. Still, one can see where its designers were starting from. The individual mandate may be onerous from a liberty standpoint, but it makes sense if you understand that insurance markets are vulnerable to a phenomenon known as the “death spiral.”

The idea behind the death spiral is based on the recognition that insurance is a risk management scheme. Insurance companies, despite their best efforts, are less knowledgeable about its customers’ health than are their customers. As such, the prices an insurance company charges are based on the average risk that a customer will need care. (more…)

It has been over a year since the passing of the Affordable Care Act, and we are still discovering problems with it. Supporters claimed passing the bill will help everyone, especially the vulnerable. However, the Affordable Care Act ironically does just the opposite by placing the elderly in a very dangerous position. Dr. Don Condit, author of the Acton monograph a Prescription for Health Care Reform, explains how the Affordable Care Act negatively impacts the elderly and its violation of subsidiarity in this week’s Acton Commentary. Get Acton News & Commentary in you email inbox every Wednesday. Sign up here.

A Sugar Coating for the Bitter Pill of ObamaCare

By Dr. Don Condit

Remember Mary Poppins singing, “A spoonful of sugar helps the medicine go down in the most delightful way”?

If so, be concerned, because you or your parents are probably on Medicare – or will be soon — and last week the Department of Health and Human Services (HHS) proposed regulations for Accountable Care Organizations (ACOs).

The sugar-coated rhetoric in this announcement from HHS cannot disguise the bad medicine in this part of this part of the Affordable Care Act, which intends to bureaucratically cut as much as $960 million in Medicare spending over three years. This ObamaCare prescription  threatens patients, the physicians who care for them, and the common good. The only clear winners are the consultants and lawyers busy trying to decipher this 429-page tome of acronyms and encrypted methodology that will compromise the doctor-patient relationship and is contrary to the principle of subsidiarity.

Medicare beneficiaries will be “assigned” to 5,000 patient-minimum organizations to coordinate their care. While HHS Secretary Kathleen Sebelius talks about improvement in care, the politically poisonous truth is that Medicare is going broke and ACOs are designed to save money. The words “rationing” or “treatment denial” or “withholding care” are not part of her press release, but reading the regulations reveals intentions to “share savings” with those who fulfill, or “penalize” others who fall short of, the administration’s objectives. The administration’s talking points include politically palatable words which emphasize quality improvement and care enhancement when the real objective is cost control by a utilitarian calculus.

Physicians and other health care providers will find themselves in conflict with the traditional ethos of duty to patient within ACOs. Ever increasing numbers of doctors are leaving private practice and becoming employed by hospitals, due to a variety of challenges inherent in these uncertain times. The hospitals are the most likely recipient of bundled payments for caring for Medicare patients. Doctors will face agency conflicts between the time honored primary duty to patient, which may conflict with hospital administration, and ACO goals of fiscal savings. Medical care providers will receive incentives for controlling spending, and penalties if they do not. “No one can serve two masters” (Matthew 6:24). Not even physicians.

The physician’s ACO conundrum is illustrated in the language where these regulations proclaim that, “Providers should be accountable for the cost of care, and be rewarded for reducing unnecessary expenditures and be responsible for excess expenditures.” Yet the very next sentence stipulates that, “In reducing excess expenditures, providers should continually improve the quality of care they deliver and must honor their commitment to do no harm to beneficiaries.” (page 14)

The principle of subsidiarity guides policy makers to empower decision making and scarce health care resource allocation at the doctor-patient level. However, the Affordable Care Act moves in the opposite direction. It increases bureaucratic power and responsibility. This is not the antidote needed to reform health care in the United States. The complexity, cost, and confusion of implementing these ACO regulations defy comprehension. We can only hope ACOs will follow “just say no” HMOs into the historical ash heap of misguided health policy.

There is no question that significant – and scarce — health care resources are consumed in the Medicare population toward the end of life. ACOs intend to limit this spending — the government way. The Ethical and Religious Directives by the United States Conference of Catholic Bishops suggest a better path forward:

While every person is obliged to use ordinary means to preserve his or her health, no person should be obliged to submit to a health care procedure that the person has judged, with a free and informed conscience, not to provide a reasonable hope of benefit without imposing excessive risks and burdens on the patient or excessive expense to family or community. (32)”

The patient must be the focal point of concern. They, or their surrogate, with the help of their physician, need to become informed. They must also participate in the expense of their care, which will better allocate resources for the community than would more distant bureaucratic panels or regulation.

Furthermore:

A person may forgo extraordinary or disproportionate means of preserving life. Disproportionate means are those that in the patient’s judgment do not offer a reasonable hope of benefit or entail an excessive burden, or impose excessive expense on the family or the community (57).

Enabling all patients, with and without means, to “proportionally” participate in the cost of their care will better allocate scarce health care resources than further sugar-coated, and non-delightful, misguided administrative policies.

By the way, if you didn’t recognize the Mary Poppins song, that’s OK. Worry instead about your grandparents for now, and consider how your generation will counter-reform ObamaCare in the future.

Dr. Donald P. Condit, MD, MBA is an orthopaedic surgeon specializing in hand surgery in Grand Rapids, Michigan. After graduating with a BS in Preprofessional studies at the University of Notre Dame he attended the University of Michigan Medical School. At the Seidman School of Business of Grand Valley State University his emphasis of study was economics and the ethical allocation of scarce health care resources. With his family, he serves annually with Helping Hands Medical Missions in El Salvador. He also volunteers at Clinica Santa Maria and for Project Access, for the uninsured, in Kent County. He is the author of A Prescription for Health Care Reform and is a Clinical Professor of Surgery at Michigan State University.