Kline, Ryan, and Upton’s Republican Off-Ramp from Obamacare

 

Tomorrow is the day the Supreme Court hears oral arguments in King vs. Burwell, and all the talk is about what Congress will do if the Supreme Court directs the Administration to obey the law by not paying subsidies in the majority of states, which have declined to establish their own Obamacare exchanges and defaulted to the federal one.

The Wall Street Journal ran an op-ed (available by subscription) by John Kline, Paul Ryan, and Fred Upton, who chair committees of jurisdiction in the House of Representatives that will be tasked with proposing a Congressional response to this decision. Here’s what they write:

Let people buy insurance across state lines. Stop frivolous lawsuits by enacting medical-liability reform. Let small businesses band together so they get a fair deal from insurance companies.

Obamacare Subsidies Made Up One Fifth of Government Transfer Payments in January

 

January’s Personal Income and Outlays report from the Bureau of Economic Analysis shows how significant Obamacare’s subsidies are in the scheme of government transfer payments to households, accounting for 21 percent of the increase in government transfer payments in January:

Personal current transfer receipts increased $24.8 billion in January, compared with an increase of $13.8 billion in December. The January estimates of current transfer receipts reflected several special factors…… Other government social benefits to persons was boosted $5.3 billion, primarily reflecting health insurance premium subsidies paid in the form of tax credits to enrollees of the Affordable Care Act exchanges.

The Fall of Government Unions And Slowing Health Costs

 

An op-ed in the Wall Street Journal (available by subscription) about a recent legal decision on retiree health benefits shines the light on is a reason for optimism about the slow growth in health spending.

As readers know, I look pretty closely at the economic data from various government agencies, and they are starting to show an uptick in health spending and prices. However, a recent Supreme Court decision weakens the power of government unions to demand exorbitant retiree health benefits, according to Robert C. Pozen and Ronald J. Gilson.

Guess Where Fair and Transparent Hospital Prices Exist?

 

Britain has long had an active cash market for medical care provided by private hospitals, which helps people get around the long waits in the National Health Service, and also serve people from abroad.

Nuffield Hospitals advertises firm, fixed, all-inclusive prices good for 60 days after an initial consultation. For more complex procedures, one pays for the initial consultation and the hospital develops the price from that. The Nuffield price generally includes post-operative care, rehab, and required readmissions.

Like Walmart, Nuffield will match competitor prices under reasonable conditions — “If you find an alternative private hospital in your local area offering a better price for the same surgical intervention, sold with the same service conditions, we’ll lower our price to equal it.” The conditions require the other private hospital be within 15 miles of the Nuffield hospital, exclude NHS private patient prices and require a written quote.

Bupa offers private insurance, elder care, and private hospitalization. Beneficiaries of its Health Cash Plan pay providers, send Bupa the bill and receive the Bupa contract amount in cash. Bupa advertises no pre-authorizations to see specialists and 24/7 phone consultation with nurses and GPs.

Licensing Out-of-State Doctors: Half of Medical Boards Perform Poorly

 

caduceus_blogTelemedicine embraces technologies as diverse as surgeons operating robots remotely, radiologists reading scanned images remotely, or psychiatrists conducting therapy sessions via videoconference. A new research article in the Telemedicine and E-Health Journal shows how difficult state regulatory barriers are making it for doctors to practice effective telemedicine.

One barrier to effective adoption of telemedicine is that states license physicians, and those licenses are not portable. When physicians seek licenses in other states, they face pointless administrative hassles.

Health Spending Chews Through A Weak Economy

 

Today’s second estimate of fourth quarter Gross Domestic Product (GDP) confirmed what we pointed out from the initial estimate released on January 30: Health spending is chewing up more and more of the weakening economic recovery.

GDP growth was actually revised down from the initial estimate of 2.6 percent to a second estimate of just 2.2 percent. In dollar terms, it was a drop from $106 billion to just $88.1 billion.

Health spending, initially estimated at $20.4 billion was tweaked up a little to $21.4 billion. In other words, health spending devoured one quarter of GDP growth in the fourth quarter.

These are the wages of Obamacare: An increasing share of our prosperity diverted to a health sector that is increasingly frustrating to patients and physicians alike.

The Future of Medicine and the Internet of Things

 

As previously noted on this blog, investments in digital health ventures doubled in 2014. Institutions, analysts and MDs envision the opportunity to reduce the colossal inefficiency of current medical practice by exploiting the Internet of Things.

According to a recent JAMA article, the number of mobile devices connected via the internet is doubling every five years, and there will be nearly seven connected devices per individual by 2020.

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Source: Digital Medical Tools and Sensors from JAMA.

The National Health IT Czar Does Not Need A Big Budget Hike

 

A similar version of this Health Alert appeared at Forbes.

One overlooked “ask” in the President’s 2015 budget was a 25 percent hike in the budget of the Office of the National Coordinator of Health Information Technology (ONC). Admittedly, it is a small amount of money, $75 million. Nevertheless, it is a 25 percent hike in a budget that should be reduced.

Although the costs of operating the ONC are small, it has an outsized role in determining how health information technology (HIT) is being deployed. HIT includes a wide range of products, technologies, and services, such as electronic health records (EHRs), mobile and telehealth technology, cloud-based services, medical devices, and remote monitoring devices, assistive technologies, and sensors.

The experience of the ONC in its first few years of existence warns against allowing it to exert too much control over HIT. In 2004, the ONC was originally envisioned as the “coordinator” of HIT. However, in 2009, the ONC became the financier, certifier, and regulator of much of HIT. The federal government allocated a 5-year budget of $30 billion to disburse as incentives to hospitals, physicians’ offices, and other health facilities, as encouragement to install electronic health records (EHRs). ONC was given the power to certify EHRs that would qualify providers for the incentive payments.  A new NCPA study concludes that this has proven expensive, unproductive, and potentially harmful, which leads to the conclusion that the federal government should play a minimal role in guiding HIT over the next decade.

FDA Allows Direct-To-Consumer Genetic Tests

 

One year after a very public squabble with genetic-testing company 23andMe, the Food and Drug Administration has decided not only to allow 23andMe to directly market its genetic test to consumer as a diagnostic device, but to free other genetic-testing companies from pre-market review or prescription status:

“The FDA believes that in many circumstances it is not necessary for consumers to go through a licensed practitioner to have direct access to their personal genetic information. Today’s authorization and accompanying classification, along with FDA’s intent to exempt these devices from FDA premarket review, supports innovation and will ultimately benefit consumers,” said Alberto Gutierrez, Ph.D., director of the Office of in Vitro Diagnostics and Radiological Health in the FDA’s Center for Devices and Radiological Health. “These tests have the potential to provide people with information about possible mutations in their genes that could be passed on to their children.”

More Evidence We’re Winning the War on Cancer

 

This blog has previously presented evidence of America’s remarkable success in the war on cancer. The factors leading to success included lifestyle changes (especially quitting smoking) as well as improved diagnosis and treatment.

New research looks only at diagnosis and treatment, and finds stunning improvements since 1990:

Men and women ages 50 to 64, who were diagnosed in 2005 to 2009 with a variety of cancer types, were 39 to 68 percent more likely to be alive five years later, compared to people of the same age diagnosed in 1990 to 1994, researchers found.

“Pretty much all populations improved their cancer survival over time,” said Dr. Wei Zheng, the study’s senior author from Vanderbilt University in Nashville. (Andrew M. Seaman, Reuters)

Improved diagnosis and treatment result from good research and development in the medical-device and pharmaceutical industries, not government-imposed mandatory health insurance.