Free the Health Insurance Market

The failure of Republicans to “repeal and replace” ObamaCare with a pro-liberty alternative, as disappointing as that is for those of us who want to see health care move in the direction of freer markets rather than more government controls, at least offers a good opportunity to reconsider some fundamentals about health insurance. Then hopefully we can get it right next time. Continue reading “Free the Health Insurance Market”

FDA Deserves Some Blame for Unnecessary Teeth Drilling

Recently my wife had to pay $1,500 out of pocket to crown a molar. This was necessary because, years ago, a dentist over-drilled a cavity in the tooth and then packed it badly, resulting in the tooth eventually cracking.

It turns out that the drilling probably wasn’t even necessary. A dentist could have simply brushed a treatment on the cavity, and that would have been that—except that the treatment, used widely elsewhere, was illegal in the United States, thanks to the onerous medical approval processes Congress imposed via the Food and Drug Administration. Continue reading “FDA Deserves Some Blame for Unnecessary Teeth Drilling”

Vaccinations and the Misreporting of the “Parent’s Bill of Rights”

If there’s one thing I hate more than faulty reporting of a political issue, it’s when the faulty reporting is mine. Earlier today on Twitter I wrongly accused Progress Now Colorado of misstating the text of a bill, Colorado Senate Bill 15-077 (the “Parent’s Bill of Rights”). I apologized for that, and I here apologize again. The basic issue is whether and in what respect the bill touches on parental choice with respect to vaccinations.

Unfortunately, some of the other reporting of the bill significantly mischaracterizes it—including that by Progress Now Colorado. Here I’d like to clarify what the bill actually says, correct my own factual error, and comment on other reporting about the bill.

Some preliminary remarks: I have no position on the bill in question, because I have not researched it adequately to reach a position on it. Offhand, it seems like an overly ambitious, overly broad bill. (It will almost certainly fail, so I see little need to look more closely into it at this time.)

As a matter of political strategy, the bill represents a massive failure for the Colorado GOP. The state senate is definitely in play next year, and Democrats will almost certainly use this bill to scare parents about outbreaks of horrific diseases. My state senator, Laura Woods, a cosponsor of the bill, likely will suffer hit pieces on the matter—we live in an extremely competitive district that until recently was held by Democrats. (In an email about the bill, Progress Now Colorado explicitly named Woods and only her, even though she is not the bill’s primary sponsor.) The bill, introduced January 14 (see the legislature’s web page), winds through the legislature just when national debate rages about vaccinations. So why stir that pot for a bill that doesn’t even have a chance to pass, especially using the names of at-risk legislators? Strategically, the bill is idiotic.

Cleverly taking advantage of the media storm surrounding vaccinations, Progress Now Colorado described SB-77 this way in an email this morning:

One of the worst attacks we’re seeing right now is on public health and education. News reports this week show that Colorado has the lowest rate of childhood vaccinations in America. Right-wing politicians like Rand Paul have come under fire for suggesting that vaccines might be responsible for mental health problems in children, even though that theory has been totally discredited by scientific research.

Right on cue, Colorado conservatives in the Senate have introduced a bill reaffirming the “right” of parents to not have their children vaccinated. With outbreaks of preventable diseases like measles and whooping cough making nationwide headlines, is there a worse message we could send to Colorado parents?

The email’s description is technically accurate but incomplete. The nine-page bill includes a single line about immunization. Here’s what the relevant section of the bill states:

The board of education of a school district, in consultation with parents, teachers, and administrators, shall develop and adopt a policy to promote the involvement of parents of children enrolled in the schools within the school district. The policy must include . . . [p]rocedures by which a parent can learn about the parental rights and responsibilities under the laws of the this state, including the right to . . . [b]e exempt from any immunization laws of this state.

In other words, the bill doesn’t do anything to alter current immunization laws; it merely directs school boards to help parents better “learn” about existing statutes. (Why parents might need the help of school boards to learn about statutes they can easily look up for themselves is beyond me.)

Again, the bit about immunization takes up a single line of a nine-page bill—yet not only Progress Now Colorado but various news outlets made it seem as though vaccinations was the primary issue of the bill.

An article by CBS4 carries the title, “Bill Would Support Parents Opting Out Of Child Vaccinations.” Although the article is technically accurate, it is misleading in that it doesn’t even mention any aspect of the bill besides vaccinations until the fourth paragraph.

The headline of a 9News article states, “‘Parents Bill of Rights’ proposal underlines vaccines, sex education opt-outs.” Again, the article (by Eli Stokols) is technically correct, yet it wrongly implies that the bill is predominantly about vaccinations and sex education. (The bill mentions sex several times, but that too is only a minor aspect of the bill.)

Stokols’s article also wrongly claims the bill “authoriz[es] Colorado parents to make all medical decisions for their children until they’re 18.”  Actually, the bill expressly allows government to intervene when there is a “compelling governmental interest” in doing so, if that interest “is of the highest order, is narrowly tailored, and cannot be accomplished in a less restrictive manner.” The bill also offers exceptions “as otherwise provided by law.”

Notably, the bill mentions neither vaccinations nor sex in its summary; instead, the summary states, “The bill establishes a parent’s bill of rights that sets forth specific parental rights related to education, health care, and mental health care of minor children.”

Given that SB-77 does not alter existing vaccination laws, but only creates new guidelines for educating parents about those laws, what do existing state laws say about vaccinations? Revised Statute 25-4-903, pertaining to “school entry,” states, “It is the responsibility of the parent or legal guardian to have his or her child immunized.” It offers exemptions for health reasons, on the basis of “a religious belief whose teachings are opposed to immunizations,” and on the basis of “a personal belief that is opposed to immunizations.” I’m not sure, but I’m guessing the statutes apply to homeschoolers and to students in private schools as well as to students in government schools. I’m also guessing that, because of the compulsory attendance laws, all parents of school-age children legally must comply with these statutes, ether getting the immunizations or filing for an exemption. Those points merit further research.

Obviously, neither Progress Now Colorado nor any Colorado Democrat is likely to come out publicly in favor of repealing the existing exemptions. So they support, at least tacitly, the exact same vaccination policy that the Republicans they’re demonizing support.

But, for some reason, neither reporters nor political hacktivists see the percentage in running the headline, “Democrats Support the Exact Same Vaccination Laws that Republicans Support, Quibble Over Providing Information”—even though that is the essential truth here.

So where did I go wrong in my initial reporting? In my initial hasty reading of the bill, I looked for the term “vaccination” and missed the related term “immunization.” That was simply an oversight. I thought Progress Now Colorado was reading an implication into the bill that it didn’t explicitly cover. I hastily Tweeted my erroneous conclusion.

Thankfully, Eli Sokols corrected me, pointing me to the relevant line in question, at which point I thanked him and apologized to Progress Now Colorado and to Alan Franklin (a supporter of that group) for my error. I again apologize to those parties, and I again express my appreciation to Stokols for taking the time to point out my error. This serves at a good reminder not to come out swinging without firmly nailing down the relevant facts.

I take solace in the fact that, with this report, I feel I’ve done the matter justice.

Update: Alan Franklin reports that “anti-vaxxers”—people opposed to vaccinations—testified today in favor of the bill. This underlines my point that, strategically, the bill is a disaster for Republicans. I bet the Democrats on the committee can barely contain their glee at witnessing the farce; it’s as though Republicans are writing the attack ads against themselves. I do find it interesting that both the opponents of vaccinations and Democratic operatives are trying to paint the bill as something that it is not: a measure altering vaccination exemptions. At any rate, in case my position was not clear by implication: Vaccines are a wonderful, life-saving medical advance, and parents generally should get their children vaccinated against the relevant diseases.

Second Update: I made yet another error in the original version of this report, and I rewrote it just before 6 pm local time to correct the mistake. (This time Alan Franklin corrected me, which I again appreciate.) Originally I saw the religious exemption in state statutes but missed the exemption for “personal belief.” Originally, I remarked that having only a religious exemption is wrong; however, because there’s not only a religious exemption, that remark was misplaced. Again, I do not have a well-developed policy position on such issues.

Third Update: In an article time-stamped 5:31 pm (but that I read some hours later), ABC7 reports that SB-77 passed out of committee on a party-line vote. The article contains this remarkable passage:

The measure also mentions the controversial topic of immunizations, underscoring current Colorado law that allows parents to opt out of vaccinating their kids for medical, religious or personal beliefs by signing a waiver. 7NEWS asked if the bill would get rid of the waiver process.

“Yes, I mean, I would assume so,” [bill sponsor Tim] Neville said.

But I see no language in the bill that would remove the waiver process for vaccination exemption; the language quoted above certainly doesn’t do that. So I must conclude either that Neville had no idea what the reporter (Lindsay Watts) was asking, or he doesn’t fully understand his own bill. (That would not come as much of a surprise; legislators have a staff to write the language of bills.)

The article also summarizes: “Opponents argued at Thursday’s Senate Education Committee hearing that the measure would prevent children being physically or sexually abused from getting help, especially if a parent was the abuser.” Although I think the fear is exaggerated, I am concerned about language in the bill such as the following: “Except as otherwise provided by law, no [party] . . . may . . . perform a physical examination upon a minor child . . . without first obtaining written consent from the minor child’s parent.” What does “as otherwise provided by law” cover, exactly? Obviously, it would be a horrible outcome if, even in some cases, abusive parents could use the law to shield themselves from scrutiny. I am, to say the least, extremely skeptical that the bill is well written and narrowly tailored to address real problems.

Latest Updates | Image: Greg O’Beirne

Watkins on How to Repeal ObamaCare

Image: Pete Souza
Image: Pete Souza

In his recent op-ed for Politix, Don Watkins paints potentially grim future for those wanting to repeal ObamaCare. He compares its history with that of Social Security, in which opposition from the right started with superficial objections and soon withered away almost entirely, such that now almost all Republicans openly endorse Social Security.

But repealing ObamaCare is not hopeless, Watkins writes, if those fighting for its repeal follow three main strategies: First, defend “the free market against those who would blame it for problems” caused by government. Second, distinguish “between an individual’s voluntary decision to support people and causes he cares about” from the moral premise “that a person’s need entitles him to support by others.” Third, “offer an inspiring moral alternative” of free markets and voluntary interactions between patients, doctors, and insurers.

Incidentally, the pdf of Watkins’s new book, Rooseveltcare: How Social Security is Sabotaging the Land of Self-Reliance, is available for free online.

How Doctors Can Improve Care, Lower Costs, and Earn More

Image: Wikimediai Commons
Image: Wikimediai Commons

In a recent interview with Concierge Medicine Radio, family physician Brian Forrest of Apex, North Carolina discusses his concierge practice (hat tip to Paul Hsieh). CMR summarizes the topics covered:

  • The shockingly simple math behind how reducing overhead and eliminating collections allows primary care physicians to spend more time providing better care while improving their take home pay.
  • How Brian kept his total operating expenses to $50k in the first year and how you can too.
  • The rule of thumb Brian uses to make all his purchasing decisions.
  • The two most effective forms of advertising for Brian’s direct pay practices.
  • How to choose your billing software and Brian’s recommendations.

For more on this innovative approach to health care, see my interview with Dr. Josh Umbehr for the Objective Standard, or see a set of collected articles about Forrest. For regular updates about health care and health policy, see the Hsieh’s blog at Freedom and Individual Rights in Medicine.

Insurance Rates Politicized under Colorado ObamaCare Regs

Image: Wikimedia Commons
Image: Wikimedia Commons

“In April, 2014, emails from Insurance Commissioner Marguerite Salazar to various Colorado officials discussed what to do about the high Obamacare premiums in Colorado’s resort counties,” as Linda Gorman discusses for Complete Colorado. At issue is the regulatory manipulation of rates in different regions. Gorman concludes, “In Colorado, Obamacare is such bad policy that it encourages politicians to take from the relatively poor and give to the relatively rich.” When politicians give bureaucrats the power to regulate insurance premiums, is anyone surprised that regulatory process becomes political and influenced by special interests?

Obama’s Reversals on Executive Power and Insurance Mandates

Image: Steve Jurvetson
Image: Steve Jurvetson

Perhaps someone has listed or will list all of Barack Obama’s many reversals between his campaigns and his presidency. Here I want to focus on two such reversals.

On executive power, Obama said, “I want everybody to understand: I taught constitutional law for ten years. I take the Constitution very seriously. The biggest problems we’re facing right now have to do with George Bush trying to bring more and more power into the executive branch, and not go through Congress at all.” As Obama now openly brags, his main strategy as president is to find ways to avoid going through Congress.

On insurance mandates, Obama opposed Hilary Clinton’s proposal to force people to buy insurance. He said, “Understand that when Senator Clinton says a mandate, it’s not a mandate on government to provide health insurance, it’s a mandate on individuals to purchase it. . . . Now, Massachusetts has a mandate right now. They have exempted 20 percent of the uninsured, because they’ve concluded that that 20 percent can’t afford it. In some cases there are people who are paying fines, and still can’t afford it, so now they’re worse off than they were. They don’t have health insurance, and they’re paying a fine. And in order for you to force people to get health insurance, you’ve got to have a very harsh, stiff penalty.” Of course, the individual mandate became a centerpiece of ObamaCare.

University of Kansas Cuts Student Work Hours over ObamaCare

Image: Steve Jurvetson
Image: Steve Jurvetson

Here’s the latest from the University of Kansas: Because of “potential fiscal liabilities with ACA,” aka ObamaCare, the “Student Employee Eligibility Requirements and Appointment Limits will reduce the hours that undergraduate students will be able to work during the semester to 20 hours per week except during breaks and summer. Previously, undergraduates could clock up to 30 hours during the academic year,” reports the University Daily Kansan. Hat tip to Campus Reform. This is just the latest illustration of ObamaCare’s impacts on employers—who became involved in health insurance in the first place almost entirely because of government.

Coffman Introduces Insurance Regulation Bill

Image: Wikimedia Commons
Image: Wikimedia Commons

Colorado Congressman Mike Coffman introduced the “Guaranteed Health Coverage for Pre-Existing Conditions Act of 2014” to “prohibit the ability of an insurance company to deny coverage based on a pre-existing medical condition in the event that the Affordable Care Act (ACA), better known as Obamacare, is repealed,” according to a July 31 media release from Coffman’s office.

In other words, Coffman wants to make sure that government smothers insurers with rights-violating regulations, whether or not ObamaCare exists. But the problem regarding pre-existing conditions is almost entirely a creation of government, which pushed most people from long-term personal insurance to (typically short-term) employer-based insurance. Is there any prominent Republican, anywhere, willing to stand up and say that government should protect rather than violate the rights of patients, insurers, and doctors?

Under Government Force CA Health Premiums Increase “Only” 4.2 Percent

Image: Wikimedia Commons
Image: Wikimedia Commons

“California officials said the more than 1.2 million consumers in the state-run Obamacare insurance exchange can expect modest price increases of 4.2% on average next year,” reports the Los Angeles Times. Of course, the fact that government can “negotiate” with insurers using brute force may have something to do with the lower-than-average increases. But starving insurance companies of premiums won’t keep the costs of health care from going up; it will only cause insurance companies to offer worse coverage or worse service. And if government artificially forces down the costs of health care, that will cause doctors to offer worse care or less service. Government can control prices (to some extent), but it can’t escape the inevitable economic consequences. If we want better services and lower prices, we must demand a free market in medicine.