news on health

Colleagues and supporters:

Thank you all for your interest in my publications and proposals to reform American health care. Today is my last day as Director of Health Care Studies at Pacific Research Institute and Executive Director of the Benjamin Rush Society. I am very grateful to have had the opportunity to contribute to PRI's efforts to reform American health care in the direction of more individual choice and less government control.

I will be leaving San Francisco (by car) tomorrow to drive across the country to Washington, DC, where I will be joining the Advanced Medical Technology Association (AdvaMed), the trade association for innovative medical-device makers on August 20.

As of today, this blog will be updated very seldom (if ever). It becomes an archive, I suppose, so plunder it as you see fit!

Best wishes,

John R. Graham

An orphan drug is a drug that treats a rare disease. In the U.S., a disease from which fewer than 200,000 is defined as rare. A Humanitarian Use Device is one from which no more than 4,000 patients will benefit.

It is very difficult to attract investment in innovation in these areas, because it is very difficult for entrepreneurs to earn a profit. Starting in 1983, U.S. law has provided incentives to promote more investment. The recently signed Food and Drug Administration Safety and Innovation Act contained a number of improvements to these policies.

Unfortunately, these reforms are unlikely to achieve the goals desired by their enthusiastic supporters - the topic of this month's Health Policy Prescription, which you can read here.

Recently, former U.S. Senator Bill Frist, MD, wrote an op-ed in which he advocated collaboration with Obamacare through establishing Health Benefits Exchanges, run by politically appointed boards which will choose health plans for individuals if Obamacare survives.

Dr. Frist's recommendations would be dangerous for any state to implement, as long as Obamacare survives.

Next week, I'll be speaking at the World Congress 3rd Annual Leadership Summit on Health Insurance Exchanges. I've uploaded notes for my presentation, "A State Needs A Health Benefits Exchange Like A Fish Needs A Bicycle," here.

My latest column for Forbes.com: The Apothecary, explaining why throwing more money at the Food and Drug Administration will not improve the productivity of regulation of medical devices. Read it here.

My latest column for the Detroit Free-Press addresses the causes and possible solutions to shortages of generic injectable sterile drugs. Read it here.

Congress recently re-authorized user fees for medical devices. These user fees are paid by the manufacturers to the Food and Drug Administration to finance the regulatory process of licensing new medical devices.

However, user fees have been in effect since 2003, and the FDA has taken in the cash without improving output. Indeed, productivity has declined significantly since user fees took effect.

Read this month's Health Policy Prescription here.

The other day, the Wall Street Journal editorialized on the failure of Republicans in Congress to propose a coherent reform to private health insurance, in the wake of Obamacare's failure.

Today, they published my letter in response. Read the letter here (no subscription required).

Here is a link to my radio interview last Sunday, which discusses scenarios in the wake of the Supreme Court's forthcoming decision on the constitutionality of Obamacare.

According to the U.S. Food and Drug Administration, the number of times that sterile injectable drugs were in short supply almost tripled from 61 in 2005 to 178 in 2010. The figure reached more than 250 in 2011.

Although the problem is complex, the possible causes can be categorized as supply-side or demand-side. But which dominates?

Supply-side factors include physical constraints due to remarkably high standards in the chain of production and in the distribution of these potentially very dangerous products. Similar constraints apply to the acquisition of the drugs’ active ingredients. Another key supply-side factor is an unproductive FDA, which has increased its regulatory burden on current suppliers and made it very difficult to get approval for new generic medicines and manufacturing facilities.

Potential demand-side factors would include government-dictated rebates or discounts for programs such as Medicare, Medicaid, and the 340B program for safety-net hospitals and clinics.

Currently proposed solutions are unlikely to address the crisis satisfactorily. Congress appears ready to give more power to the FDA - but the real solutions lie in giving more choice to patients and physicians.

Read the entire study, published by the Mackinac Center, at this link.

Last week, the U.S. House of Representatives voted to repeal Obamacare's medical-device tax. Conventional wisdom concludes it will go no farther. It can, and it should. Read the entire column at Forbes.com: The Apothecary.

How has the medical-device industry been so successful at moving repeal of its Obamacare excise tax to the front of the queue of the agenda to repeal Obamacare?

My latest column at Forbes.com tries to figure it out. Read it here.

Obamacare levies an excise tax on medical devices that will reduce research & development investment by over $2 billion every year, beginning in 2013. This will have an impact on patients' health. An initial estimate figures that this will cause a loss of one million life-years annually.

Read this month's Health Policy Prescription, by Benjamin Zycher, at this link.

Many conservatives promote the idea of interstate purchase of health insurance as a solution to the health-insurance crisis. What exactly does this mean?

In fact, health insurers "sell across state lines" already. Generally speaking, large insurers either have separate subsidiaries in different states (e.g. WellPoint) or write policies from a balance sheet in the state in which they are domiciled (e.g CIGNA).

But interstate purchase as described by conservative activists is somewhat different. In a podcast produced by the Heartland Institute, I explain why it is an impractical solution.

Listen to it here.

The Benjamin Rush Society Presents The Arthur N. Rupe Debate Series:

University of California, San Diego, School of Medicine
Medical Education - Telemedicine (MET) Building, Auditorium 9500 Gilman Avenue, La Jolla, CA 92093-0618

As we wait in cautious optimism for the Supreme Court to free us from the burden of Obamacare, let's think of some other harmful federal intrusion that would be good to get rid of. How about the curious notion that Congress should regulate health insurance at all?
Read the entire column at Forbes.com: The Apothecary.

What is unique about U.S. health care? Well, not only do we control fewer of our own health care dollars directly than our friends in other developed countries do, but we've also been going in the wrong direction for over two decades.

After defeating Obamacare, breaking this long-term trend will be a critical objective of the real health reform that replaces it.

Read the entire article here.

The Benjamin Rush Society Presents The Arthur N. Rupe Debate Series:

Harvard Medical School
Tosteson Medical Education Center (TMEC), Floor 2, Room 227260 Longwood Avenue, Boston, MA 02115

There is a split between what free-market policy analysts believe Obamacare will do to health insurers and what investors believe. Wonks tend to think that the regulatory burden imposed by Obamacare – especially increasing politicians’ power over health plans’ ability to set premiums – will demolish private health insurance.

But Wall Street sees it differently: The “individual mandate” that every American acquire health insurance has been understood as an overwhelming gift to the health insurers. Their premiums, although highly regulated, are about to become fairly risk-free. Perhaps they should be analyzed as utilities?

Read the entire column at Forbes.com.

Well, the future of American health care is now controlled by lawyers. That may not be news – doctors, drug makers, and medical-device makers have long complained about the cost of lawsuits. But this different: The future of PPACA is in the hands of the Supreme Court.

Hundreds of lawyers billed thousands of hours analyzing and preparing briefs for the case. And that’s after countless hours spent by Congressional staff lawyers putting the bill together in 2009 and 2010.

The result? A “law” so confusing that even the legislators – themselves mostly lawyers – could not bother to even try to read it. It makes one think: If the lawyers are designing the health-care system, shouldn’t they be forced to operate under regulations similar to those they’re imposing?
Read the entire article at John Goodman's Health Policy Blog.

There is no doubt that the campaign to “repeal and replace” ObamaCare will have its weakest standard bearer if Mitt Romney becomes the Republican candidate for President. His embrace of an “individual mandate” to buy health insurance or pay a penalty, as legislated in his 2006 Massachusetts health reform, is anathema to those faithful to the ideal of limited government.

But maybe we should look at it another way: If Mitt Romney had never signed his 2006 law, those of us committed to defeating ObamaCare would never be in the fortunate position we are today – the whole, ungodly mess hanging by a thin thread after a brutal hazing in the Supreme Court.

Read the entire article here.

It's not often you see budgetary sense coming out of the California state Capitol. So, we should cheer the legislators and governor who have proposed a modest reform to Medi-Cal, California's Medicaid program for low-income residents, that would have improved incentives for patients and reduced the budgetary bleeding by about half a billion dollars - if it had take place last year.

California governor Brown believes - correctly - that if Medi-Cal beneficiaries have "skin in the game," that they will make better use of the medical services that the taxpayers subsidize. Unfortunately, U.S. Secretary of Health & Human Services Sebelius has quashed this reform, on questionable legal grounds.

Read the entire Health Policy Prescription here.

I will have the honor of moderating a debate hosted by the Benjanin Rush Society of Robert Wood Johnson Medical School on the resolution that: "Health care should not be the responsibility of the federal government."

The debate will take place at the Piscataway, NJ campus, within striking distance of New York and Philadelphia, on Tuesday, April 17. There will be a wine and cheese reception at 5 p.m. and the debate will start at 6 p.m.

Each team debating the resolution is comprised of one physician and one lawyer - all four deeply involved in struggle over PPACA - and a timely combination given the Supreme Court's current litigation over Obamacare.

This debate is free, but seating is limited. Please go to this link for more information and to register to attend.

Please distribute this invitation widely, broadly and deeply.
 

I will be speaking at an event hosted by The Freedom Foundation in Bellevue, WA, on April 19. The topic is Obamacare - An Unhealthy Choice for America.
All are welcome! Please come and bring your family, friends, and colleages. If you're not available, but know folks in the Seattle area who would be interested, please let them now.

More information and registration at this link.

Obamacare is primarily responsible for the fact that health-insurance premiums are outpacing the growth in underlying medical claims. See my op-ed in the Washington Times here.