What are "retail health clinics"? Chances are, you've already seen them. These clinics have begun rapidly spreading to malls, big-box retail stores such as Wal-Mart and Target as concessionaires, and drug stores like Walgreens. Instead of hiding behind insurance co-pays, the clinics offer pricing up front to consumers, so that they can decide for themselves what to "buy" and how much they want to pay for service.

This is the same mechanism that works to keep prices down and supply consistent in other areas of health care that insurance plans do not traditionally cover. For instance, cosmetic surgery and Lasik rely entirely on consumer compensation. There are no third-party payers to get in the way of rationally allocating resources to demand. In those markets, producers and consumers find each other in the normal manner, advertising, discounts, and price competition, and the market attracts new providers when scarcity appears and prices rise.

Given the realities of pricing and competition, we should reform the health system not by building more all-encompassing insurance plans, but by returning health insurance to its rational place: as a bulwark against catastrophic loss. If consumers bought health-care services in a rational market, the price for the overwhelming majority of transactions would be well within the money we would recoup from ending comprehensive coverage policies.

People with pre-existing conditions, such as myself, could access catastrophic coverage a lot easier if insurers didn't have to pay for all of the maintenance services required. Prices would drop to a rational level where almost all families could afford coverage. Government regulation could protect consumers from suffering rejection and cancellation much as they do now.

[Emphasis mine. - PSH]

In the meantime, providers would get properly compensated, which would create growth in supply, especially in family practice, which faces a serious provider shortage.

If we want to reform care, bend the cost curve downward, and promote supply in the health-care industry, we need to learn the lesson from retail health clinics. The top-down reform proposed by Congress threatens to stop real reform and amplify everything that's currently wrong with the system.

Labels: Free Market

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The most disturbing part of the Obama-Care debate is not about where Republicans and Democrats disagree, but where they agree.

Take this issue of those with pre-existing illnesses. Many Republicans actually support government action to prevent insurance companies from refusing to insure them. Ignoring the benefits of cost-lowering free market competition and the role of charity, many Republicans believe it acceptable to force an insurance company — in business to insure against unknown risks -- to "insure" someone currently experiencing a known risk.

Sen. Tom Coburn, R-Okla., supports legislation to "eliminate pre-existing conditions" as a reason for a carrier to deny coverage. Sen. John Barrasso, R-Wyo., says government needs "to take care of things like pre-existing conditions so that that doesn't stop (people) from getting insurance."

Sen. Chuck Grassley, R-Iowa, supports prohibiting "insurers from denying coverage to people with pre-existing medical conditions or charging higher premiums to people who are sick."

But this should not surprise anyone who observes the allegedly "fiscally conservative," "pro-free market," "limited government" party in action. From the acceptance of the New Deal to government bailouts of private industry, Republicans — sooner or later -- go along.

Republican President George W. Bush, for a time, worked with a Republican House and Senate. Bush promised and delivered a prescription benefits bill for seniors. It expanded Medicare, the popular underfunded entitlement program passed — with Republican support, by the way -- in 1965. We like seniors. Seniors vote. So if they struggle with their drug bills, why, by all means make someone else help pay them.

On the 10th anniversary of the Americans with Disabilities Act, signed into law by his father, Bush bragged about the law's importance and effectiveness. That such an assault on private employers engenders praise says much about the GOP's acceptance of federal government's command and control.

Labels: Free Market, OpEd

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* Encourage portable insurance.
* Allow special health savings accounts for the chronically ill.
* Allow special needs health insurance.
* Allow health status insurance.
* Allow self-insurance for changes in health status.
* Give people on their own the same tax break employees get.
* Allow providers to repackage and reprice their services under Medicare and Medicaid.
* Allow access to mandate-free insurance.
* Create a national market for health insurance.
* Encourage post-retirement health insurance.

Labels: Free Market, Insurance

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The pause seems to be ending in the inept debate in Congress on health care. After a year of struggle, some comfort might be taken from the fact that neither of the monstrosities passed by the House or the Senate has become law.

However, truer than ever is the adage that "no man's life, liberty or property are safe while the legislature is in session." The change of one Senate seat is not a solid foundation to protect us from the threat of massive government intrusion in American medicine. And President Barack Obama's State of the Union address indicated that all the worst features of last year's House and Senate bills are likely to come roaring back.

If the best defense is a good offense, real reforms should be put forward now that permit better and more affordable health care and that expand, rather than restrict, personal choice and freedom.

The best way to evaluate reform proposals is, first, to determine the direction in which they would take us. More government spending or less? More or fewer taxes? More or fewer government agencies? More freedom and choices, or more obedience to rules, regulations and mandates? More decisions by physicians to best meet the unique condition of each patient, or more government enforcement of "protocols" that physicians must apply to all patients? Privacy for the doctor-patient relationship, or the turning over of all personal medical records to the government so it can monitor and supervise doctors' decisions?

Labels: Free Market, OpEd

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Labels: Analysis, Free Market, States, VA

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...Along with stopping mandatory insurance purchase, the Right to Health Care Choice allows people to buy more affordable policies sold in other states. Thirty states have less expensive small-group premiums than Colorado. If governments did not shield insurers from interstate competition, “12 million previously uninsured” Americans would have coverage according to University of Minnesota economists.

You have the right to buy the best available insurance policy for you and your family. You also have the right to donate to charities of your choice. The Health Care Choice Initiative would protect you from politicians who want to deprive you of choice and increase your insurance premiums and taxes.

Labels: Free Market, Insurance, OpEd

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...First and foremost, our reforms were based on the faulty notion that health care is some sort of "right" which must be guaranteed by the government. Rights are not entitlements to goods or products that must be produced by another. There is no such thing as a right to a car, or a tonsillectomy. Instead, we have the right to be left alone and purchase as much or as little health-care as we choose.

Our state's current problem are the results of policy makers, bureaucrats, lobbyists, and insurers (a few of which are my opponents) violating this basic right and limiting our freedom to purchase what we want and from whom. Now, we are forced to choose from a limited set of insurance plans on terms set by Beacon Hill and special interest, rather than ourselves.

We should repeal all laws such as community rating and guaranteed issue, which have made Massachusetts' insurance rates amongst the highest in the country. Instead, our state should allow people to buy more affordable coverage that is available in other states. By allowing insurance companies to compete across state lines, this would immediately make the best offerings of all 50 states available to Massachusetts residents. This plan also has the potential to dramatically cut insurance expenses for many residents.

I also want to allow people to set up health savings accounts (HSAs) for routine expenses and purchase catastrophic-only insurance for major expenses. Under our current system, HSA-qualified plans are unaffordable and essentially illegal. These reforms would empower patients and lower costs by making patients not just the consumers, but paying customers of medical care and insurance.

Labels: Free Market, MA, States

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...President Barack Obama thinks government bureaucrats can determine what [Beezley's diabetic son] Connor needs, when he needs it, and then get it to him--and to hundreds of millions of others. This is a lie. The President's scheme to seize control of our bodies through our health is dangerous, and will leave us helpless victims with no control over our health care. Government control also means an inevitable decline of supplies, and rationing via simpleminded regulations.

Only a system of competing prices, profits and producers--capitalism--results in the right thing being in the right place at the right time. Without prices and profits you have scarcity, rationing and poverty: the Soviet Union was one of the most fertile regions on earth; an army of central planning bureaucrats couldn't keep bread on the shelves for a reason.

It doesn't matter if rationing is "in the bill." Shortages are unavoidable without a profit-driven market providing price and profit signals to consumers and producers. Under government control doctors, insulin, test strips and all health resources will be disconnected from the needs and priorities of real people and driven instead by political priorities and the stunted thinking of bureaucrats. Freedom and capitalism respect the choices of individuals and provide incentives that align the interests of disparate people. This is true of healthcare just as surely as bread or anything else.

...There are four essential reforms [that] offer an immediate start to protecting the lives of Connor and every American. To start, the federal government must assert its authority under the Interstate Commerce Clause and knock down foolish, expensive barriers to health insurance purchases across state lines so Americans can buy the insurance they want.

As another important reform, state governments must end coverage mandates that radically increase the cost of insurance and enrich health insurance companies at patients' expense.

In addition, lawsuit abuse must be curbed with sensible malpractice guidelines and limits.

And finally, tax policy that disconnects patients from their doctors must be changed by moving tax benefits to the individual level while empowering individuals with vehicles like Health Savings Accounts.

...My son doesn't deserve to have his life diminished by a government run healthcare monstrosity.

He and all Americans deserve a free, vibrant, competitive market in health care.

Labels: Free Market, OpEd

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A government-run health insurer would radically tilt the health-insurance playing field. It would amount to a new entitlement program, able to undercut the price of private insurance by squeezing hospitals and doctors, reimbursing them at below-market rates. "Just like Medicaid and Medicare," which also underpay medical providers, the public option would force hospitals and doctors to charge private insurers more. Insurers would be compelled to raise their premiums, eventually losing millions of customers to the government plan.

Obama insists that any public option would have to be self-supporting, properly balancing its premiums and risk and not expecting the government to cover its losses. Sound familiar? The same assurances were made about Fannie Mae and Freddie Mac.

* Tear down the barriers to buying insurance across state lines
* Repeal mandatory benefits that make health insurance needlessly expensive
* De-link health insurance from employment

Labels: Analysis, Free Market

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Expect less, pay more. It's not the slogan for some "Bizarro World" Target store in a comic book; it's an accurate slogan for congressional Democrats' health care "reform" proposals. They include a new government-run insurance plan, mandatory insurance, new political controls on insurance, and new taxes.

Labels: Free Market, Insurance, OpEd

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I had a slot as one of the featured speakers. I spoke for about nine minutes, near the middle of the program, after a prominent local conservative activist. My primary message was that the Tea Party movement needs to advocate for capitalism, not just against socialism, and that the only way to do so is with a moral defense of individual rights.

Yes, we need change. But it has to be rational change. We're not out to "block health reform" as such, or "stand in the way of progress" as President Obama put it yesterday. We're out to block Washington's version of health reform, because every last facet and feature of these health reform bills serves to introduce more government into the system, not less.

...This does not have to happen in America. There is a moral defense. It's a defense that recognizes man as an end in himself, not the means to the ends of others. It's the defense that man has a right to his own life, and that we have no duty to sacrifice ourselves to the alleged benefit of others. It's the only foundation from which one can consistently defend free markets.

Labels: Free Market

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If you are in need of surgery, let Erickson Financial Services help you arrange for affordable surgery right here in the United States of America. Erickson Financial Services offers access to high quality, affordable surgery at a fraction of the cost of traditional U.S. hospitals. How do we do it? Quite simply, Erickson Financial Services acts as a liason between our clients and reputable, licensed practitioners who offer direct-pay services at reasonable, non-negotiable rates. There is no charge for our services.

If you are a citizen of the United States of America, there is no need for you to look towards medical tourism as a solution for your unresolved healthcare needs. The USA offers some of the highest quality healthcare services in the world. Why leave the country when you can receive services right here in the USA at prices comparable to those in countries such as Thailand?

Erickson Financial Services offers no guarantees with regards to surgical outcomes. Once we have put the client into contact with a doctor or facility, we are no longer involved with any interaction between doctor and patient. It is up to the client to do his/her own due diligence to determine whether he/she wishes to receive services from the physicans that we refer.

Labels: Free Market

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...In a free market, insurers and consumers voluntarily make an agreement to mutual benefit. When politicians dictate what policies and services will be sold and to whom, those politicians undercut people's ability to reach insurance agreements that work best for them.

In a free market, companies that don't take care of their customers risk losing them to a competitor, creating an incentive to provide the best service at the best price. When there is no free market for health insurance, there is less competition, resulting in less need to out-bid competitors for our business.

A free market also depends on the reliability of contracts. Once a contract between an insurance company and an individual is made, breaking that contract should be punishable by law. This means that if an insured individual's coverage is dropped when they find a medical problem that was covered, they should be able to sue the company for breach of contract.

It is true that many people today with pre-existing conditions have trouble finding affordable coverage. But politicians, not a free market, created the problem.

Currently, employer-based insurance makes it difficult for those with pre-existing conditions to stay on the same insurance because it is not portable. Current tax law that favors employer-sponsored insurance over directly purchased plans makes it more likely individuals will be tied to their employer for insurance.

Insurance is meant to hedge against unforeseen, catastrophic events or illnesses, as opposed to covering every doctor visit. If it were, protection against major health problems or accidents would be possible for a majority of individuals and pre-existing conditions would be much less of a worry for those who need coverage...

Labels: Free Market, Insurance, OpEd

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National researchers have now officially blessed both the quality and the pricing of fast-growing retail clinics. They say the care is as good as, and sometimes better than, emergency rooms and regular doctors' offices, and the fees are dramatically lower.

While the limited-care retail centers may not solve the entire health care mess on their own, Dr. Ateev Mehrotra said they are "intriguing."

Burgeoning retail health outlets are "providing care at a lower cost, at a higher quality, where it's more convenient," Mehrotra said. He wrote a RAND Corp. study in August praising costs and outcomes at retail clinics treating ear infections, sore throats and urinary tract infections.

Labels: Free Market

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...Rights that Americans would lose under proposed reforms include: the right to buy true insurance, for which premiums are based on risk; the right to decline to buy a plan they don't want; the right to self insure; the right to reap the benefits of healthful living, hard work, and prudent spending; and the right to keep their medical records confidential. If the reforms evolve into a single payer, as many advocates intend, Americans would lose the liberty to use their own property to prolong or enhance their own lives.

Obligations that reform would impose on Americans include: continually proving that they had paid for coverage that the federal government deems acceptable; paying what the government deems to be their "fair share" for insuring persons below a certain income threshold; paying for procedures they deem to be harmful or immoral if coverage is mandated by government; and paying for expanded, costly bureaucracy.

America's extraordinary prosperity and technological progress occurred in an atmosphere of freedom. The losses resulting from a central chokehold on innovation are incalculable. Advocates of reform often attribute the high cost of American medicine to new drugs, devices, and procedures, and want still-heavier regulation to restrain these advances. Both Americans and the result of the world's peoples will lose if America is no longer the engine of progress.

Americans are being asked to exchange their birthright of freedom for -- politicians' promises. And to trade their natural, God-given rights to life, liberty, and property for government-granted privileges or entitlements.

The source of man's rights is not divine law or congressional law, but the law of identity. A is A -- and Man is Man. Rights are conditions of existence required by man’s nature for his proper survival. If man is to live on earth, it is right for him to use his mind, it is right to act on his own free judgment, it is right to work for his values and to keep the product of his work. If life on earth is his purpose, he has a right to live as a rational being: nature forbids him the irrational.

Labels: Analysis, Free Market

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...Like every grieving family member, I looked for someone to blame for my father's death. But my dad’s doctors weren't incompetent -- on the contrary, his hospital physicians were smart, thoughtful, and hard-working. Nor is he dead because of indifferent nursing -- without exception, his nurses were dedicated and compassionate. Nor from financial limitations -- he was a Medicare patient, and the issue of expense was never once raised. There were no greedy pharmaceutical companies, evil health insurers, or other popular villains in his particular tragedy.

Indeed, I suspect that our collective search for villains -- for someone to blame—has distracted us and our political leaders from addressing the fundamental causes of our nation’s health-care crisis. All of the actors in health care -- from doctors to insurers to pharmaceutical companies -- work in a heavily regulated, massively subsidized industry full of structural distortions. They all want to serve patients well. But they also all behave rationally in response to the economic incentives those distortions create.

* Health Care Isn't Health (Or Happiness)
* Health Insurance Isn't Health Care
* The Moral-Hazard Economy
* There's No One Else to Pay the Bill
* The Government Is Not Good at Cost Reduction
* Our Favored Hospitals
* You Are Not the Customer
* The Strange Beast of Health-Care Technology
* The Limits of "Comprehensive" Health-care Reform

Labels: Analysis, Free Market, Insurance, Medicare

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...I too believe that the government must reverse its inappropriate manipulation of the health care industry and turn to free market solutions to repair the problems that prior government intervention has created.

I believe that the government's only proper role is the protection of individual rights. Interference by the government in the health care and insurance industries violates individual rights by forcing unwilling participants to pay for a predatory collective, by pressing physicians and other independent professionals into involuntary servitude for the sake of some mysterious, shape-shifting and ultimately illusory "common good," and by dictating the terms upon which an insurer can operate. This regulatory interference causes the rising cost of health care and diminishing access to the quality and innovation that only the profit-motive can supply.

The "public option" and "single-payer" health care proposals being advanced by disinterested power-seeking central planners in Washington would mean a government bureaucracy interfering in the private relationships between doctors and their patients. It is a subversion of the individual's right to contract. It is a subversion of the right to use one's judgment to act in one's own best interest without interference. It is a subversion of the right of doctors, nurses and insurers to voluntarily offer products and services to satisfied health care consumers for their mutual benefit.

...As philosopher Ayn Rand urged throughout her life, political and economic freedom are requirements of life. Statism serves to undermine those ends while capitalism serves to further them. Capitalism is not right because it works, it works because it is right.

TIM PECK
ASHEVILLE NC

Labels: Analysis, Free Market

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• Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts (HSAs)

• Equalize the tax laws so that employer-provided health insurance and individually owned health insurance have the same tax benefits.

• Repeal all state laws which prevent insurance companies from competing across state lines.

• Repeal government mandates regarding what insurance companies must cover.

• Make costs transparent so that consumers understand what health-care treatments cost.

Dear Whole Foods,

My wife and I have been customers of Whole Foods for many years now, here in the Denver metro area.

We were delighted to read CEO John Mackey's excellent piece in the Wall Street Journal proposing genuine free market health care reforms rather than the usual heavy-handed top-down government-mandated "solutions", which is all we're hearing lately.

In particular, I applaud his recognition of the fact that there is no "right" to health care. This is the fundamental moral issue underlying the health care policy debate. Any attempt by the government to guarantee a false "right" to health care must necessary violate the actual individual rights of patients, providers, and taxpayers. Hence, I'm glad that Mr. Mackey is proposing solutions that will lower health costs for Americans while respecting our individual rights.

This country was founded on principles of freedom and individual liberty. I'm glad that CEO Mackey recognizes and respects that fact. As a result, my wife and I are delighted to continue to give our business to Whole Foods and we will encourage our friends and colleagues to do so as well.

Sincerely,

Paul Hsieh, MD
Freedom and Individual Rights in Medicine (FIRM)
http://www.WeStandFIRM.org

Dear Whole Foods --

I have been a regular shopper at Whole Foods for the past year, but now I have more to appreciate about your stores than your fine nuts, hearty meats, and pungent cheeses. I salute CEO John Mackey for his op-ed proposing free market health care reforms.

I am particularly grateful for Mr. Mackey's clear statement that health care is a need not a right. Too often, people think that their want creates an obligation on the part of others to satisfy it. In fact, a person is responsible for satisfying his own needs and wants in life. His rights to life, liberty, and the pursuit of happiness enable him to do that: they allow him the freedom to act in pursuit of his own goals without forcible interference from others. They do not allow him to rob and plunder his neighbors. If that is permitted by law, the results are exactly as Ayn Rand portrayed in "Atlas Shrugged."

I realize that many Whole Foods shoppers support socialized medicine, so I particularly appreciate Mr. Mackey's willingness to speak out on this issue. Such courage is rare in America today.

Thank you!

Diana Hsieh (Ph.D, Philosophy, CU Boulder)
Sedalia, Colorado

Labels: Free Market, OpEd

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Myth No. 1: Employer Mandates Would Make Coverage Affordable.
Myth No. 2: Insurance Costs Can Be Limited to 10 Percent of Income.
Myth No. 3: Guaranteed Issue and Community Rating of Premiums Protect Consumers.
Myth No. 4: Expanding Government Insurance Improves Access to Care.

Problem: Employer Mandates Are a Tax on Employees.
Problem: Employer Mandates Are Limited by Federal Law.
Problem: Individual Mandates Are Difficult to Enforce.
Problem: Individual Mandates Are Vulnerable to Special Interests.
Problem: Mandated Acceptance Raises Premiums.
Right Solution: A National Insurance Market.

Labels: Analysis, Free Market, Insurance

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...Many people, just as they become eligible for Medicare, discover that the insurance rug has been pulled out from under them. Some doctors -- often internists but also gastroenterologists, gynecologists, psychiatrists and other specialists -- are no longer accepting Medicare, either because they have opted out of the insurance system or they are not accepting new patients with Medicare coverage. The doctors' reasons: reimbursement rates are too low and paperwork too much of a hassle.

...Dr. Knope, the author of "Concierge Medicine: A New System to Get the Best Healthcare," has this kind of practice in Tucson. His patients sign a contract agreeing to pay $6,000 a year for individuals and $10,000 a year for couples. The fee covers office visits, physical exams and phone consultations, and Dr. Knope will meet patients in the emergency room, see them in the hospital and occasionally make house calls.

A list of about 500 concierge doctors throughout the country is available on Dr. Knope's Web site, www.conciergemedicinemd.com.

Is the care worth the money? Harold and Margret Thomas, who are in their mid-70s and live in Cincinnati, spend the winter in Tucson. After many phone calls, the couple were unable to find an internist in Tucson who took new Medicare patients, so they signed with Dr. Knope in 1996. Five years ago, when Mrs. Thomas developed a blinding headache, her husband called the doctor at 8 o'clock one night, and he, suspecting an aneurysm, insisted they get to the emergency room immediately.

The doctor met them and ordered an M.R.I. and a CT scan. The tests revealed an aneurysm, and Dr. Knope found a surgeon who quickly operated. Medicare paid for the emergency room, the surgery and the hospital stay.

"If there were a concierge practice in Cincinnati, I’d be part of it there, too," Harold Thomas said.

Labels: Free Market, Medicare

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Free markets can solve this problem, and provide life-long, portable health security, while enhancing consumer choice and competition. "Heath-status insurance" is the key. If you are diagnosed with a long-term, expensive condition, a health-status insurance policy will give you the resources to pay higher medical insurance premiums. Health-status insurance covers the risk of premium reclassification, just as medical insurance covers the risk of medical expenses.

With health-status insurance, you can always obtain medical insurance, no matter how sick you get, with no change in out-of-pocket costs. With health-status insurance, medical insurers would be allowed to charge sick people more than healthy people, and to compete intensely for all customers. People would have complete freedom to change jobs, move, or change medical insurers. Rigorous competition would allow us to obtain better medical care at lower cost.

Labels: Free Market, Insurance

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Health Matters

Dale Haralson was the kind of patient some doctors would rather avoid. In 2005, the Tucson, Ariz., lawyer had a triple-bypass operation, then contracted an infection that spread to his chest, lungs, blood and bone. He needed more surgery and was told he would need a permanent feeding tube. But few surgeons wanted to take his complex case.

A former partner recommended that he see Steven D. Knope, a local primary-care doctor who treats a small group of patients in exchange for an annual fee. Dr. Knope took over Mr. Haralson's care, and found a skilled and willing surgeon and a pulmonologist who said that, instead of a feeding tube, he just needed to use an inhaler every day.

Today, Dr. Knope handles all the routine medical care for Mr. Haralson and his wife, Betty, and tracks the couple's general health and fitness. Together, they pay him $10,000 a year, and think it's money well spent. "All you need is one crisis and a good outcome and you know it's worthwhile," says Mr. Haralson, age 71, who exercises regularly, still practices law and still eats chocolate cake.

The kind of "concierge medicine" that Dr. Knope practices is gaining popularity across the U.S., particularly among older Americans with complex medical needs...

Maintain your private medical care if at all possible. If you are relatively healthy, look into a high-deductible health insurance plan linked to a Health Savings Account (HSA). Start putting money away in that HSA for a rainy day. Find a "concierge physician" or doctor with whom you can establish a direct financial relationship; someone who will act as your medical advocate in a system that is broken and will only get worse. You get what you pay for and medicine today is no different.

Labels: Analysis, Free Market

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...[A]s long as the annual fee for a physical exam does not exceed the market value of the services, the business model would not be considered "insurance." For practices offering bundled fees for unlimited office visits, the report says contracts must define the services and use market values to avoid being considered insurance.

Labels: Free Market, Insurance, MD, States

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Cosmetic and LASIK surgery
Laboratory testing
Pharmaceuticals
Retail health clinics
Concierge medicine
Medical tourism

Labels: Analysis, Free Market

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First, the title Forbes selected carries a very interesting message: "Should You Dump Your Primary Care Doctor?" It would seem that Forbes is effectively calling concierge medicine the "gold standard" by which readers should judge their own primary care doctor. If your doctor doesn't measure up -- if you don't have adequate access to and time with your doctor -- perhaps you should consider "dumping" him and paying for better care. This is a far cry from the uniformed criticism that was levied against concierge doctors in the early stages of this movement. It would appear that people are beginning to get the idea that doctors cannot provide excellent medical care without the time to do so.

Second, the comments from Joseph Heyman of the AMA are revealing in their ignorance and represent nothing more than political rhetoric:

"...[H]e says, physicians 'should provide the same quality of care to all patients regardless of the model of care in which they are practicing.'"

Really? Let's examine this statement from the chairman of the Board of Trustees of the AMA. Doctors should somehow provide the same level of care in a traditional, third-party practice (in a 7 minute visit) that a concierge doctor provides to his patients in a 30 minute visit. And just how does a physician do this, Dr. Heyman? The corollary of this statement is already recorded in the AMA position statement on concierge medicine: There is nothing intrinsically unethical about concierge medicine, they say, provided that doctors do not advertise concierge medicine as somehow better than the standard, fast-food medical model.

When is the AMA going to stop spewing this political nonsense and start telling the truth? If I didn't think spending more time with a patient was better care, I wouldn't do it. Most concierge doctors take excellent care of about 600 patients. This is plenty. Suggesting that a doctor can do the same job while taking care of 3,000 patients is nonsense. It is clearly refuted by a large body of literature, which shows that primary care doctors do not have the time to adequately address the needs of their patients, much less address their preventative care, which is now being touted by the nationalized healthcare advocates as a part of our needed "reform."

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A health care sharing ministry (HCSM) provides a health care cost sharing arrangement among persons of similar and sincerely held beliefs. HCSMs are not-for-profit religious organization acting as a clearinghouse for those who have medical expenses and those who desire to share the burden of those medical expenses. These organizations are known as health care sharing ministries (HCSM).

* HCSMs receive no funding or grants from government sources.
* HCSMs are not insurance companies. HCSM do not assume any risk or guarantee the payment of any medical bill. Ten states have explicitly recognized this and specifically exempt HCSMs from their insurance codes.
* HCSMs serve more than 100,000 members, with members in all fifty states.
* HCSMs' members share more than $60 million per year for one another’s health care costs.
* HCSMs strive to be accessible to members regardless of their income, because traditionally shares are a fraction of the cost of insurance rates.

Some people can't afford medical care in the U.S. But they are necessarily a small minority in a free or even semi-free country. If they were the majority, the country would be an utter bankrupt and could not even think of a national medical program. As to this small minority, in a free country they have to rely solely on private, voluntary charity. Yes, charity, the kindness of the doctors or of the better off -- charity, not right, i.e. not their right to the lives or work of others. And such charity, I may say, was always forthcoming in the past in America. The advocates of Medicaid and Medicare under LBJ did not claim that the poor or old in the '60's got bad care; they claimed that it was an affront for anyone to have to depend on charity.

CONCERNS: Mandating health insurance will infringe on the religious and economic liberties of members of health care sharing ministries and ultimately destroy these unique ministries.

• Mandatory Insurance Will Cripple An Innovative Approach to Meeting Health Care Expenses. HCSMs are the result of a cooperative effort of individuals and employers organized around a religious principle of "bearing one another's burdens" in a time of need. Requiring these sustaining communities to use their scarce resources to purchase health insurance or pay taxes and penalties for failing to do so will drain the financial lifeblood from these vibrant ministries.

• Mandatory Insurance Infringes on Religious Liberty. Members of HSCMs are presently in charge of the decisions regarding their own health care and able to refrain from supporting practices contrary to their moral convictions. Mandatory insurance, on the other hand, would legally require the purchase of insurance policies that force citizens to give financial support to treatments that violate their convictions.

• This Innovative Solution to Rising Health Care Costs Works. HCSM members help with medical burdens by sending a monthly share that is significantly lower than individual or employer insurance rates. HCSMs also provide the spiritual and emotional support of a community of believers that helps to heal the whole person rather than just the illness.

THE SOLUTION: Do not mandate the purchase of health insurance. Instead, give increased liberty to all consumers and allow them to control their health care dollars. In HCSMs this approach has resulted in greater individual control of health care spending and improved quality of care...

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...[L]et's deregulate medical care so that providers can find innovative ways to deliver high-quality care cheaply. Let's eliminate the increasingly strict education requirements for clinicians and let medical professionals offer walk-in physicals or other services at competitive prices. Like Wal-Mart and MinuteClinic, they will rely on brand name and reputation to assure quality.

We also need to better promote health savings accounts, which put spending in the hands of consumers and encourage them to shop around for low-cost alternatives.

Retail clinics are only the first step. My hope is that the increased access and reduced costs will quickly become evident and will build support for additional innovations -- and the deregulatory policies necessary to make them possible.

Universal coverage sounds appealing, but it means government will be running the trains. Here and abroad, government does not have a good record when it comes to access, oversight or innovation.

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"Health Savings Accounts: A year-long look at adoption, usage and funding patterns"

* HSAs have application across income groups, consumer life stages and varied employer environments.

* To encourage participation and make plans as useful as possible, employers should consider making contributions to the accounts. Even in their early years, HSAs show evidence of flexing to the specific needs of savers versus spenders.

* Positive balances at year-end are an encouraging indicator of HSAs ability to help make health care more affordable.

Labels: Free Market, HSA, Insurance

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Free market reforms healthier than Amendment 56

By Paul Hsieh, MD
Friday, September 19, 2008

This fall, Colorado voters must decide whether to require all businesses with more than 20 employees to provide health insurance for their employees (Amendment 56). Although voters may be tempted to say "yes," this is an immoral and impractical solution to the problem of rising health insurance costs.

It is morally wrong because it violates the rights of employers and employees to negotiate to their mutual self-interest in a free market.

Businessmen create jobs through rational thought and hard work. Consequently, they have the moral right to decide on what terms to offer those jobs to prospective employees, including specific wages and benefits.

Similarly, workers have the right to negotiate for any specific wages and benefits they desire, and the right to reject job offers that don't meet their criteria. But they have no right to demand a specific salary or benefit from employers (such as health insurance) via government force.

Two motivations behind this proposed law are (1) the mistaken notion that health care should be a guaranteed "right," and (2) the desire to force businesses (rather than government) to pay for this supposed obligation. But health care is a need, not a right. A right is a freedom of action in a social context, such as the freedom of speech.

It is not an automatic claim on a good or service that must be produced by someone else. There is no such thing as a "right" to a car or an appendectomy. Any attempt by the government to guarantee a false "right" to health care can only be done by violating the actual rights of someone — in this case, business owners.

Forcing businesses to provide health insurance to employees will also cause serious economic harm to Colorado. Such a law would cause many businesses to fire workers, outsource jobs, or cancel plans to hire new workers. This will disproportionately harm unskilled workers and those at the lower end of the income scale — the very people the measure is intended to help.

According to Howard Roerig, owner of Seale & Associates, Inc. in Centennial, "This measure will have a chilling effect on all small businessmen. Although I don't have 20 employees at present, I would make certain never to hire that 20th person. The costs would be so high that I would be better off starting another firm in a different state, and letting it do business in Colorado as an out-of-state firm.

"I would have to find some means of skirting this measure or else close my doors."

Other states such as California have driven away many businesses and jobs due to high taxes and heavy regulations. Colorado must not repeat these mistakes.

To "solve" the problem of high insurance costs by foisting those costs onto businesses would be just as wrong as "solving" the problem of rising gasoline prices by forcing businesses to pay their workers' gasoline expenses.

Our current high health care costs have been caused by decades of government interference in the free market. Hence, the proper solution is not more government regulations, but instead free market reforms that addressed the problems caused by prior government controls.

Some examples of free market reforms include allowing Coloradans to purchase health insurance across state lines and eliminating mandatory insurance benefits. Patients should be allowed to purchase Health Savings Accounts (HSAs) for small routine expenses and insurers should be allowed to sell low-cost catastrophic-only policies to cover rare but expensive events. These measures could greatly reduce insurance prices and allow patients to purchase from the best offerings of all 50 states, thus making insurance available to thousands of Coloradans who want to purchase it but currently cannot afford it. Furthermore, the state legislature could adopt these reforms without permission from the federal government.

If Coloradans want to address the problem of high health insurance costs, they should reject the Amendment 56 and instead demand free market reforms. This is right for employers, right for employees, and right for Colorado.

Paul Hsieh, MD, of Sedalia is co-founder of Freedom and Individual Rights in Medicine (FIRM)

Labels: CO, Free Market, Insurance, OpEd, States

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Medical Licensing: An Obstacle to Affordable, Quality Care

...One view is that state licensing of medical professionals assures quality. In contrast, I argue here that licensure not only fails to protect consumers from incompetent physicians, but, by raising barriers to entry, makes health care more expensive and less accessible.

...Consumers would benefit were states to eliminate professional licensing in medicine and leave education, credentialing, and scope-of-practice decisions entirely to the private sector and the courts.

End Government Licensing

...The more complex the field, the more destructive coercive licensing is, because the more urgent it is that there be freedom of thought and action. In a vast, continually evolving field like medicine, in which a huge and growing range of medical procedures exists, each requiring different skill sets, it is absurd and incredibly costly to have the government reserving jobs for full-fledged MDs that could be done by other medical professionals, while giving an official stamp of approval to MDs who do jobs that they lack necessary specialized knowledge to do (such as general practitioners who prescribe complex psychiatric medications).

It may be funny when governments takes charge of licensing fortune tellers, but it is deadly when it is in charge of licensing doctors. We should abolish the government's coercive licensing power and unleash a free market of objective-standards bodies who function by persuasion, not compulsion.

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...Health-care paternalism creates another problem that's rarely mentioned: Many people can't afford the gold-plated health plans that are the only options available in their states.

Buying health insurance on the Internet and across state lines, where less expensive plans may be available, is prohibited by many state insurance commissions. Despite being able to buy car or home insurance with a mouse click, some state governments require their approved plans for purchase or none at all. It's as if states dictated that you had to buy a Mercedes or no car at all.

Labels: Free Market, Insurance

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Knope... said he doesn't submit insurance claims to Blue Cross or any other insurance company for his 120 concierge patients. However, he has another 100 patients who are not part of his concierge practice. If Blue Cross terminates his contract, he said he will be forced to drop some of those patients.

"It is not going to hurt me financially, but it is going to hurt my (traditional-practice) patients," Knope said. Blue Cross "is hurting no one but their own members."

Because concierge doctors do not work for third-party payers, because we contract directly with our patients for medical care, being dropped from an insurance plan does not affect us. It does not affect our patients. The real story is not that another insurance company behaved badly. The real story is that it didn't matter!

I'm all for free-market medicine and competition. Concierge medicine is the first example of real competition to enter the medical marketplace in years. This interchange with BC/BS is an example of how the free-market sorts things out. Blue Cross has every right to refuse to do business with me. Likewise, I can decline to do business with them. I don't need the government to protect me from "big business." I can simply offer a different kind of medical care and allow the public to choose where they want to spend their healthcare dollar.

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1) The fact that patients are willing to pay you directly for your services means that you have a good reputation in the community. We know that lousy doctors cannot sustain a concierge practice.

2) Concierge practices are smaller than traditional practices. By sheer number, the risk of lawsuits is smaller. You have several hundred patients as opposed to several thousand.

3) You have more time to spend with each patient. You are less hurried. You are able to be more meticulous and pay greater attention to detail. This lowers your risk of human error.

4) Though you are capable of making a mistake, you actually have a relationship with your patients. You know them personally. You spend a great deal of time trying to do the right thing for them. Even if you make a mistake, your patients will be more likely to forgive you for human error.

5) Finally, we have looked at over 200 practice years of concierge physicians. To date, we have been unable to identify a single judgment against a concierge physician.

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Myth # 1: The only ethical way to save our medical system is to create a universal health care system managed by the government and abandon private medicine.

Myth #2: Concierge Medicine doctors only see wealthy patients, abandoning the poor and middle class.

Myth #3: Health care is a right! People should not have to pay for their healthcare.

Myth #4: Concierge doctors are only concerned with money. There is no reason that they cannot care for complex patients with multiple medical problems in an eight-minute office visit.

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Concierge medicine is an appealing option for some primary-care doctors who want to break free from the assembly-line method of patient care that they say they are forced to adopt.

Primary-care doctors say this limited practice is appealing for many reasons. They cite the drumbeat of threatened pay cuts from government programs such as Medicare and the red tape and restrictions of private insurance companies. Other factors include the rising cost of malpractice insurance and the expense of hiring assistants and office managers who must push paperwork.

The trend underscores the fact that the role of primary-care practitioner is a less appealing option for young doctors who see more lucrative career paths in specialized areas of medicine such as dermatology or plastic surgery.

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Liberal proponents think of mandates as social insurance. Many of the uninsured are younger and healthier, they note, so forcing them into insurance pools will result in lower average premiums. Some conservatives, meanwhile, argue that uninsured people use emergency rooms but often don’t pay, offloading their health costs onto the rest of us. It's not simply about coverage, in other words; it's also about personal responsibility. At a debate in Texas, Clinton made a similar argument, claiming that without mandates, "every one of us with insurance will pay the hidden tax of approximately $900 a year." Conservatives like Duke University health expert Christopher Conover, former Massachusetts governor Mitt Romney, and former Republican National Committee chairman Ken Mehlman have all made some version of this claim.

...[E]vidence shows that costs are influenced much less by mandates than by consumers’ ability to buy a broad range of competing health-insurance products. An insurance policy for a single male resident in mandate-enforced Boston, for example, costs five times more than a policy for his identical twin in mandate-free Tucson. This cost disparity is due in part to the Bay State's many insurance regulations, which limit the types of policies that consumers can buy and drive up prices. As for the responsibility argument, uncompensated care costs federal and state governments roughly $40 billion a year—in a health economy that tops more than $2 trillion annually. That's a very small percentage of the total expenditure and certainly doesn’t amount to a hidden tax of $900 per person.

...Mandates offer the illusion of fixing our health-care problems by extending insurance to all.

Labels: Free Market, Insurance, MA, States

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Safeway Joins Rivals In Adding $4 Generic Prescription Drugs

Safeway will begin offering $4 prescriptions on hundreds of generic drugs today at stores in the eastern United States, a spokesman said, following in the footsteps of the program popularized by Wal-Mart two years ago.

The list of $4 drugs includes the antibiotic amoxicillin, blood pressure medication atenolol and levothyroxine for thyroid disease.

...Safeway's move comes after Wal-Mart rattled the retail industry when it launched its $4 prescriptions in 2006.

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The big lie behind politician-controlled medicine

Re: "Who has your health at heart?" May 22 guest commentary.

AFL-CIO executives John Sweeney and Mike Cerbo perpetuate the big lie behind politician-controlled medicine: that the free market is not working and that costs have been spiraling out of control because of markets.

But costs have been increasing precisely because of the employer-based insurance they espouse, which is a consequence of a biased and non-free-market tax code. It favors employer-based insurance and penalizes other types of medical insurance.

We consume medical care like a business traveler dining on the company's expense account: Since someone else pays the bill (insurers), patients need not shop around, so providers don't compete on price. Why?

Tax-discounted insurance encourages us to buy more costly insurance than we probably need, hence penalizing saving for future medical expenses. Our "insurance" has become prepaid health care.

Employer-based insurance also coddles insurance companies, which have little incentive to please consumers. They know we're essentially locked to our employer and the costly insurance plans they offer. To buy a competitor's product, we must change jobs or pay a stiff tax penalty.

The AFL-CIO should be ashamed of promoting self-serving policies that both empower labor unions and result in expensive medical care and insurance.

Brian T. Schwartz, Boulder

Labels: Free Market, Insurance, LTE

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