One Year After Veterans Waiting List Scandal, Doctors Only 2,000 of 23,000 New VHA Hires


I hate to bring this up right after Independence Day, but the Veterans Health Administration appears to have devolved from an expensive and failing bureaucracy to an even more expensive and failing bureaucracy.

We have  already discussed that waiting lists have grown one year after the scandal broke. Now, see what they’ve done with the billions of dollars Congress handed them in the wake of the scandal:

o Bonuses at the most troubled VA facilities ran virtually unabated.
o Out of 23,000 new employees added to the employment counts during the scandal, fewer than 2,000 were doctors. Less than 1 in 12 new hires were doctors.
o At the troubled Hines VA in Cook County, IL bonuses leapt to three year highs, but the number of doctors actually decreased.
o Across the system, the VA cut the number of accountability positions: inspector general, auditors, and quality assurance officers.
o There are only 23,768 doctors in the system, but over 338,297 total employees. It’s still an employment farm, not a medical system.
o Yet, the VA increased the Public Relations Directors total salaries by $3,000,000. Painters, Interior Decorators, and Gardeners also increased in headcount and salaries.

(Open the Books, July 4, 2015)

Happy Independence Day


American Eagle

Best wishes for the July 4th long weekend. Blogging recommences on Monday.


Health Jobs Outpace Soft Employment Report


Health jobs keep growing faster than other civilian, nonfarm jobs. Health care added 40,000 jobs in June, almost one in five of the 223,000 jobs added. At a seasonally adjusted growth rate of 0.27 percent, health jobs continue to grow significantly faster than other jobs, which grew at 0.14 percent (see Table I).

20150702 TI

The ACA’s ‘Tanning Tax’ Harms Women-Owned Business


By Cherylyn Harley LeBon

In the wake of the King v. Burwell Supreme Court decision, Congress must now turn their attention to fixing the most harmful parts of the law. As it turns out, the Affordable Care Act has not been “affordable” for women who own tanning salons — or their customers. The so-called Tanning Tax imposed a 10 percent excise tax on tanning bed services, in addition to state sales taxes and taxes paid by the tanning salon owner.

The Tanning Tax’s impact on the tanning industry has been devastating. Since the tax was implemented in 2009, nearly 10,000 tanning salons have closed, according to the American Suntanning Association. This has resulted in a loss of 81,000 jobs. For instance:

Leaked: Obama’s Trade Deal Includes Strong Intellectual Property Rights


I had been concerned that the Trade Promotion Authority, which Congress just granted the president, would be problematic because the president would not push for strong intellectual property protection in international trade agreements, especially the Trans Pacific Partnership.

I am glad to learn that I was wrong (or that the administration heeded my concerns):

A recent draft of the Trans-Pacific Partnership free-trade deal would give U.S. pharmaceutical firms unprecedented protections against competition from cheaper generic drugs, possibly transcending the patent protections in U.S. law.

The draft text includes provisions that could make it extremely tough for generics to challenge brand-name pharmaceuticals abroad. Those provisions could also help block copycats from selling cheaper versions of the expensive cutting-edge drugs known as “biologics” inside the U.S……

(Michael Grunwald, “Leaked: What’s in Obama’s trade deal,” Politico, June 2015)

When the official draft comes out, this will cause lots of controversy in the U.S. and abroad.

Oregon Health Plans Ordered to Raise Rates!


All that complaining about double-digit Obamacare rate hikes for 2016? Well, at least one Insurance Commissioner thinks they’re not high enough. Plans in Oregon have lost so much money on Obamacare that the state’s Insurance Commissioner fears for their solvency unless they hike premiums more than they have asked for:

The Oregon Insurance Division says it is pushing health insurers to charge higher individual rates in 2016 because they are reporting huge underwriting losses for 2014.

The insurers collected just $703 million in premiums for 2014 and spent $830 million on 2014 claims, officials say.

(Alison Bell, “5 Oregon insurers under orders to raise their rates,” LifeHealthPro, June 19, 2015)

Shrinking Health Construction Spending: Consolidation to Blame?


This morning’s release of construction spending from the U.S. Census Bureau indicates spending on health facilities actually shrank a little in May, a significant downturn from the previous release (see Table I, below the fold). Total construction spending amounted to about $1 trillion, of which $39 billion was health care. Health construction spending shrank 0.6 percent from April and grew only 3.1 percent year on year. Total construction spending, less health, grew 0.9 percent on the month, and 8.4 percent year on year.

We look at this because other economic data indicate that health spending is consuming more of our prosperity. Low, even shrinking, spending on construction of health facilities may represent the consolidation of hospitals that many fear will lead to increasing prices.

Over-the-Counter Contraceptives Better than a Mandate


“The Pill” turned 50 in May of 2010.  With the advent of oral contraceptives, couples had far better contraceptive options.  Democratic supporters of Obamacare wanted to make contraceptives more affordable by mandating contraceptive coverage.  Many supporters view the mandate as a feminist issue and assume anyone who opposes it is waging a war on women. The problem is that mandated benefits are not free; they come with costs that would be more efficiently borne by individuals.

Republican Senators Kelly Ayotte (R-NH) and Cory Gardner (R-CO) also want to make birth control pills easier to afford — and more accessible.  They sponsored Senate Bill 1438, Allowing Greater Access to Safe and Effective Contraception Act. S.1438 would encourage the sale of hormonal contraceptives over the counter (OTC) without a prescription.

Only 20 to 40 Cents of Each Medicaid Dollar Benefits Recipients


One of the problems with Medicaid is that it does not appear to improve recipients’ health (although the evidence can be described as mixed). The best evidence on Medicaid comes from Oregon, which ran a lottery to allow eligible people to enroll. This approximates a randomized clinical trial, the gold standard of clinical research and hard to achieve when examining the real world. Plenty of research indicates that the Oregon Medicaid did not improve health outcomes very much.

The original researchers continue to publish results, and have written a paper that might offer the best explanation why Medicaid does so little. Only 20 to 40 cents of Medicaid spending actually goes towards patients’ welfare:

Strict Antitrust Review for Health Insurers, Hospitals


As Obamacare accelerates the transformation of the U.S. health sector into a complex of regulated utilities, providers are concentrating into oligopolies. The Wall Street Journal reports that the U.S. Department of Justice will use “strict review” when considering mergers of health insurers, while the Federal Trade Commission will also review hospital mergers closely:

The prospect of consolidation poses high stakes for the Obama administration, whose signature domestic policy legacy is the 2010 health-care law. Some aspects of the health law were designed to increase insurance-industry competition, including marketplaces for health coverage and the creation of new nonprofit cooperative health plans around the country.

But the law also includes provisions that may have helped inspire consolidation, at least indirectly.

(B. Kendall & A. Wilde Mathews, “DOJ Girds for Strict Review of Any Health-Insurers Mergers,” Wall Street Journal, June 28, 2015)