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Book: Medicare Harms Patients And Impairs Doctors

Some housekeeping chores I didn’t get to last week.  First, thanks to Richard Eisenberg, who did an interview with me about Medicare’s Victims: How the U.S. Government’s Largest Health Care Program Harms Patients and Impairs Physicians, that appeared at both Forbes and PBS’s Next Avenue.  Here’s a bit from the interview:

And you also say a lack of coordination of care leads to undertreatment for Medicare patients, especially regarding pharmaceutical use and cancer. Tell me about this.

It can get very confusing with medications, doctors appointments and treatments. It helps to have a coordinator. Medicare doesn’t pay for care coordination, so there’s no incentive to coordinate care, except with the Medicare Advantage program. Without coordination of care, there’s a higher rate of hospital readmission.

When Medicare was established, if you were 65 or older, there wasn’t much you could do for some of these medical conditions. No one anticipated you could keep people alive for decades. Medicine has evolved, but Medicare hasn’t adapted.

Next, thanks to Allan Wallace and the Pittsburgh Tribune.  Wallace gave Medicare’s Victims a nice little review on the Tribune’s Review page.  A few days later the Tribune ran an editorial entitled “Medicare @ 50: Sick, getting sicker,”  that included these paragraphs:

David Hogberg, an analyst for the National Center for Public Policy Research, has documented how Medicare rules and regulations harm patients and doctors in his new book, “Medicare’s Victims.” That betrays the original Medicare legislation’s prohibition against federal interference in doctor-patient relationships, he reminds.

Mr. Hogberg calls Medicare “a sick program … that needs to be seriously revamped.” And the longer that unjustified optimism about this big-government mess delays reform, the longer that taxpayers, hospitals, doctors and patients will suffer.

Cool!  And thanks!


Why ‘Medicare-for-All’ Is A Terrible Idea

Yesterday I had another article at The Federalist examining Robert Reich’s push for single-payer health care, a.k.a. “Medicare-for-All.”  This was one of the more enjoyable pieces I’ve written in a while, so here is an excerpt:


And what is Reich’s solution to [rising costs]? As he states at the beginning of the article, “Medicare offers a way to reduce these underlying costs—if Washington would let it.”

I can see it now: You are slapping your forehead, exclaiming, “If Washington would let it! Why didn’t I think of that?!”

Well, Washington won’t let Medicare make such changes because it is filled with groups such as hospital and physician associations that have a vested interest in keeping a cash cow like Medicare largely the way it is. Those vested interests don’t care for the competition that would arise if Medicare started changing what it paid for.

Plus, why Medicare’s lower administrative costs is a silly argument, erroneous health care comparisons, why the sickest people will suffer under such a scheme, and more.


Medicare's Unhappy 50th Anniversary

Today is the 50th Anniversary of President Lyndon Johnson signing Medicare into law.  The Daily Caller published my article today explaining why that is nothing to celebrate.  Here is an excerpt:

Medicare has a dark underbelly that is seldom given much attention in the media. Certain patients, often the sickest, are harmed by Medicare’s policies. Grandiose promises were made when Medicare was signed into law. Yet, as the example of patients like Dolores makes clear, the program has failed to live up to its promises.

When President Johnson signed Medicare, he said, “No longer will older Americans be denied the healing miracle of modern medicine.”  Yet Medicare denies treatment routinely, even when a physician recommends that treatment.

That is another thing Medicare was not supposed to do.  The first part of the legislation, entitled “Prohibition Against Any Federal Interference,” makes a fairly explicit promise that Medicare would not interfere with the doctor-patient relationship. It states, “Nothing in this title shall be construed to authorize any federal office or employee to exercise any supervision or control over the practice of medicine.”

Physicians are ready sources of complaint about how Medicare interferes with their practice.

The article focuses on Dolores Reiss and Clay Bell, two Medicare patients who were denied much needed speech and physical therapy due to Medicare’s rules.  The article traces their struggles.  But you can read their full stories in my book, Medicare’s Victims: How the U.S. Government’s Largest Health Care Program Harms Patients and Impairs Physicians.  


The Silliest Argument in Favor of Medicare-For-All

Easily the most absurd claim advanced by the Medicare-for-All (i.e. single-payer) crowd is that Medicare is more efficient than private sector health insurance because it has lower administrative costs.


There are numerous problems with that argument, not the least of which is that comparing government administrative costs with private sector ones is usually an apples-to-oranges comparison.  Michael Cannon of the Cato Institute has a great criticism of the argument here.


But that doesn’t stop someone like Robert Reich, who should know better, from using it:


Medicare’s administrative costs are in the range of 3 percent.

That’s well below the 5 to 10 percent costs borne by large companies that self-insure. It’s even further below the administrative costs of companies in the small-group market (amounting to 25 to 27 percent of premiums).

To make this simple, let’s apply that logic to other areas of the government.  It’s quite possible that AmTrak has lower administrative costs than Georgia Southwestern, and the Post Office’s Priority Mail Service has lower administrative costs than Federal Express.  I’ll wait for Reich to argue that freight rail and overnight delivery would be more efficient if run by the government, but I won’t hold my breath waiting.


Medicare's Victims: What Readers Are Saying

My new book, Medicare’s Victims: How the U.S. Government’s Largest Health Care Program Harms Patients and Impairs Physicians, received its first review on Amazon:

I am a patient of Dr. Juliette Madrigal-Dersch, and I thoroughly enjoyed the section about her and her practice. She is a wonderful doctor who has taken good care of me since 2003. I would never consider seeing another doctor. Just spending thirty minutes with her makes me feel better emotionally and I always know her care plan for me is accurate and in my best interest. Thank you for your excellent book. My mother has recently fallen into the doughnut hole again and your book helped me understand that pitfall. 

Now that is the type of review that really warms the heart.

It also received praise from Todd Keefer, who goes by the Twitter handle @FreeMktMoney. He had this to say:


Thanks, Todd!

He also added this:



Couldn’t have tweeted it better myself.


ObamaCare + Illegal Immigration + California = Insanity

I’m not really sure where to start with this, so let’s just start with the basics.  From the San Jose Mercury News:

A first-in-the-nation bill aimed at expanding health care for illegal immigrants sailed through the Senate on Tuesday even as some lawmakers acknowledged that thousands of legal residents are having to struggle to access health care through the state’s Medi-Cal program.

In a 28-11 vote, a newly pared-down version of Senate Bill 4 by Sen. Ricardo Lara, D-Bell Gardens, would let undocumented Californians buy health insurance with their own money through the state’s Covered California exchange if the state is given a waiver by the federal government. It would also allow anyone age 18 and under to enroll in Medi-Cal regardless of immigration status — and let undocumented immigrants age 19 and up enroll in Medi-Cal if there’s money provided in the state budget.

Since the Obama Administration has no problem taking unilateral action on illegal immigration, I don’t see why Obama would have a problem granting a waiver.  You mean it’s probably illegal to do that?  Yeah, like that would stop him.

I think the only question is whether the Obama Administration would make illegal immigrants eligible for premium subsidies.  That might be problematic, since that would require illegals to file tax returns with the Internal Revenue Service.  Then again, the IRS might not even notice since it seems preoccupied with other things these days.

The most troubling aspect of the bill is the provision that lets the kids of illegal immigrants on to Medicaid (Medi-Cal in the Golden State).  Wonder what message that sends south of the border?  Something like, “Cross the border into California and get free health care for your kids”?

Finally, you know it is crazy time in California when Governor Jerry Brown looks like the reasonable one: If the bill “clears the Legislature, the measure goes to Brown, who could veto it.”


Justin Danhof Criticizes Apple CEO Tim Cook on Fox Business Network

On yesterday’s episode of the Fox Business Network’s “Cavuto: Coast-to-Coast,” Justin Danhof of the National Center for Public Policy Research criticized Tim Cook’s handling of Apple. Danhof, the Director of the Center’s Free Enterprise Project, was especially critical of Cook’s diversion of resources away from core business to products that aren’t popular and to political issues like the environment.

More information about the Free Enterprise Project and the history behind Justin Danhof and Tim Cook, including the “Tim Cook moment”, can be found here:


Horace Cooper Discusses the Bill Cosby Rape Allegations with Dr. Drew

Did U.S. District Judge Eduardo C. Robreno have the right to release sealed documents regarding past allegations about Bill Cosby? Is a suspect’s right to privacy dependent upon how many accusers he has, or upon how famous he is?

On last night’s episode of HLN’s “Dr. Drew” show, Horace Cooper of Project 21 and the National Center for Public Policy Research addressed these issues and more.

Additional comments from Horace about this issue can be found in this press release:…


Medicare Pits Doctors against Patients

A quick note:  Tomorrow I’ll be presenting my book, Medicare’s Victims, at the Heritage Foundation at Noon.  Details here.

Today the Washington Examiner has run my article, “Medicare’s midlife crisis: Catastrophic finances pit doctors against patients.”  In it I examine Medicare’s financial difficulties and how that leads to government interfering in the doctor-patient relationship.  Here is a snippet:

When Medicare became law in 1965, the first part of the legislation was titled, “Prohibition Against Any Federal Interference.” It states, “Nothing in this title shall be construed to authorize any Federal office or employee to exercise any supervision or control over the practice of medicine,” a rather explicit promise that Medicare would not interfere with the doctor-patient relationship.

If this was an attempt to assuage the public, it was dishonest. A later section of the law stated that “no payment may be made under part A or part B [of Medicare] for any expenses incurred for items or services … which … are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.” That put Medicare on a collision course with the doctor-patient relationship. Inevitably some physician would deem a treatment “reasonable and necessary” that Medicare did not.


Here is a prediction on Medicare’s future:


This is where a government healthcare program like Medicare inevitably leads. As the program’s costs exceed the means to pay for it, expenses must be reduced. Members of Congress will, of course, reduce Medicare’s costs in ways that cause them the least amount of political trouble.


That means the sickest Medicare patients will suffer the most because they are the most politically powerless. First, relatively few people get seriously ill each year, too few to have much impact on congressional elections. Second, because they are ill, they are in no condition to be organizing, protesting, getting media attention and the other things that can compel Congress to change Medicare policy. Finally, some of them are so ill that they won’t be around much longer to cause Congress any headaches.

Read it all.

Dissecting Medicare

Thanks to PJTV, which has aired the first television interview about my new book, Medicare’s Victims: How the U.S. Government’s Largest Health Care Program Harms Patients and Impairs Physicians.

It’s part of a series called “Keeping Your Gold In Your Golden Years.”  The host, John Phillips, and I discussed issues such as whether Medicare is a good program as long as you don’t get sick, what is Medicare’s one fundamental flaw, how safe is his grandmother on Medicare, and whether Medicare-for-All is a good idea. 

You can view the PJTV interview here.

You can also watch it below.

Oh!  And Medicare’s Victims is available at AmazonBarnes & Noble, and Lulu. Just in case you were wondering.


Think Progress Discovers Gentlemen Prefer Blondes and Other Lite Fare

It’s Friday, so I’ll leave my book alone for now and focus on some less serious matters.

1. From Think Progress:  “Serena Williams Beat Maria Sharapova For The 17th Straight Time. But Serena Still Makes Less Money.”  This is one of those great stories where the laughter starts with the headline.  While Williams has dominated Sharapova in recent years, “it is Sharapova, not Williams, who makes the most money,” according to TP. “In 2014, she was listed as Forbes highest paid athlete, earning $24.4 million. Serena earned $22 million.”

Oh my Gawd, I think I’m having a fainting spell!  You can guess what TP claims the cause of this gross injustice is.  (“Isn’t it nice that TP is concerned about injustice among the 1%?” — the Wife.)

2. The Annivesary of the End One of the Worst Marketing Decisions of All Time.  Tomorrow is the 30th anniversary of the introduction of Coca-Cola Classic.  If you’re not aware of what that means, you were probably born sometime after about 1975.  For more, go to 4:43 here:


3. Moore vs. Krugman Death Match!  On Wednesday at Freedom Fest, Stephen Moore and Paul Krugman had a very informative and, at times, spirited debate over the topic of “How can we best restore the American Dream?”  While the debate is not yet online, my friend Elizabeth Sheld has a very good report about it at PJ Media.

4. And, Oh, By The Way.  Did you know there is a new book out about Medicare?  Available at Amazon, Barnes & Noble, and Lulu.  My friend David Catron highly recommends it.


Pointing Out Harm Reduction Gains

Tobaccocigarettee cigDPCW

Tobacco harm reduction is one of the most important issues to the Risk Analysis Division. We believe that proper (limited) regulation of reduced risk products such as e-cigarettes and snus, a type of smokeless tobacco, can save more lives than any new tax, warning label, or ineffective “public service” campaign.

I often have to remind my colleagues that changing minds, especially on a topic as emotionally charged as this one, takes time. Gains will come, but only incrementally. Yesterday, after writing a letter about the issue to a group of Massachusetts legislators, I got to remind myself how those gains can go unnoticed. 

First, here’s the letter:

Dear Members of the Joint Committee on Public Health (JPH) and Rep. Finn,

I’m writing in reference to HB1943 - An Act to study the use of harm reduction, sponsored by Rep. Finn, to be considered at your upcoming meeting. 

As a policy analyst on science-based policies to reduce the deadly toll of smoking tobacco, I am pleased that your committee will deliberate this issue. I have long advocated that regulators consider the use of harm reduction as a strategy for reducing cigarette smoking in the Commonwealth, thereby reducing death, disease and health care costs associated with the use of cigarettes.

I am also pleased that Congress has incorporated the concept of harm reduction in the Family Smoking Prevention and Tobacco Control Act, which gives the Federal Food and Drug Administration authority to regulate tobacco products.

In fact, the FDA has already begun evaluating harm reduction, especially with regard to e-cigarettes, in its regulatory approach. The agency will soon finalize the proposed ‘deeming regulations’ which will set a framework for regulating e-cigarettes.” 

In addition, together with the National Institutes of Health, the FDA is in the midst of a national longitudinal study called Population Assessment of Tobacco and Health (PATH), which includes multiple evaluations of how people are using e-cigarettes, to help better develop e-cigarette regulations based on real-world usage.

Given the major financial resources and scientific expertise being deployed by the FDA, I would respectfully suggest that the commonwealth rely on the federally funded science, rather than requiring the Massachusetts DPH to do its own, more limited study.

That said, it is worth keeping in mind comments from the FDA’s chief tobacco regulator, Mitch Zeller, who toldthe Robert Wood Johnson Foundation’s NewPublicHealth that, 

“…if at the end of the day people are smoking for the nicotine, but dying from the tar, then there’s an opportunity for FDA to come up with what I’ve been calling a comprehensive nicotine regulatory policy that is agency-wide and that is keyed to something that we call the continuum of risk: that there are different nicotine containing and nicotine delivering products that pose different levels of risk to the individual.
Right now the overwhelming majority of people seeking nicotine are getting it from the deadliest and most toxic delivery system, and that’s the conventional cigarette. But if there is a continuum of risk and there are less harmful ways to get nicotine, and FDA is in the business of regulating virtually all of those products, then I think there’s an extraordinary public health opportunity for the agency to embrace some of these principles and to figure out how to incorporate it into regulatory policies.   

This principle, together with the FDA’s scientific and population based evaluations of e-cigarettes, will be valuable tools for the Commonwealth as it considers appropriate regulations to incorporate the use of harm reduction as a strategy for reducing cigarette smoking.



Jeff Stier

Senior Fellow, National Center for Public Policy Research

Director, Risk Analysis Division

Now, the reflection. A liberal Massachusetts legislator authored a piece of legislation encouraging the state’s health department to study how tobacco harm reduction could save lives. I supported a 2012 Indiana law that required the state to take into account the benefits of “tobacco harm reduction” when making policy. Who would have thought, that in 2015, now even democrats in Massachusetts are considering endorsing the idea as well.  While I don’t think the Massachusetts legislation is a good use of resources at this point in time, nonetheless, it is worth noting as a marker of our incremental progress.


Does Medicare Impoverish the Disabled?

In my new book, Medicare Victims: How the U.S. Government’s Largest Health Care Program Harms Patients and Impairs Physicians, I examine how the disabled fare with Medicare’s cost sharing.

One disabled woman that I interviewed for the book was Francine English, who is now, sadly, deceased. For her, the problem was Medicare’s cost sharing.  For example, Medicare Part B requires beneficiaries to pay 20 percent of any treatment; Medicare pays the other 80 percent.  Most seniors on Medicare have some type of supplemental insurance, often called Medigap, that covers the cost sharing.  But it’s expensive, and if you’re like Francine who was getting about $10,000 annually from Social Security Disability Insurance, you’re not able to afford the premiums.  At the time I interviewed her, Medicare’s cost sharing had caused her to run up about $2,000 in medical debt.

One of the things I found most interesting while researching this book is that there doesn’t appear to be any research on the amount of medical debt incurred by the disabled who are on Medicare.  It would seem to be a prime area for research.  You have patients who are often quite ill, need a lot of health care, and often don’t have the means to pay for Medicare’s cost sharing.   But no one, apparently, had looked at this phenomenon. Thus, I had no way of discussing the extent of the problem.

The best I could do was to examine whether there were a lot of disabled people on Medicare who had trouble accessing care because of the cost sharing.  As a I noted in Tuesday’s blog post, there is a lot of evidence that disabled people on Medicare do have trouble accessing care because of cost.  Thus, if there are a lot of disabled patients who don’t access care because of cost, it would likely follow that there disabled patients who run up a lot of debt because they do seek care.  

Unfortunately, I don’t have a good explanation for what is arguably the biggest problem most overlooked by health care researchers at least in regards to Medicare.  Perhaps it has something to do with the fact that the vast majority of health care researchers are liberals and, as such, probably have little interest in digging into the shortcomings of government programs.  But that’s just a theory.

Nevertheless, it is an area that should be thoroughly researched because it’s quite possible that Medicare may impoverish some of our most vulnerable citizens by saddling them with medical debt.


Medicare’s Victims is available at Amazon, Barnes & Noble, Lulu, and iBookstore


Government Interferes with the Religious Liberty of Christian Colleges

After the recent U.S. Supreme Court ruling on same-sex marriage, many Christians expressed concern that the decision might result in government interference with the religious liberty of Christian institutions.  As it turns out, federal ObamaCare mandates are doing that already.

My alma mater, Wheaton College, just lost a court challenge related to ObamaCare’s emergency contraceptive mandate.

Wheaton’s community covenant requires all students and faculty to “uphold the God-given worth of human beings, from conception to death.”  

ObamaCare, on the other hand, requires that the College’s health insurance company cover all contraceptive measures, including those methods that destroy a fertilized ovum after sexual intercourse — methods that many Christians consider to be abortifacients.

Apparently, our right to freedom of religion is not as important as our right to cheaply dispose of our unborn children.


Medicare Helps the Disabled--Or Not

As noted in an earlier blog post, the leftist Commonwealth Fund is publishing a series of papers this month under the heading “Medicare at 50 Years.”

The first report released under this series is entitled, “Medicare: 50 Years of Ensuring Coverage and Care.”  The Executive Summary of the report claims, “there is a lot to celebrate. For 50 years, Medicare has accomplished its two key goals: ensure access to health care for its elderly and disabled beneficiaries, and protect them against the financial hardship of health care costs.”

But as one gets a bit deeper into the report, the achievements of Medicare change:  “In its first 50 years Medicare has unquestionably achieved its two basic goals: to ensure that Americans 65 and older have access to health care, and to protect them and their families from severe financial hardship from medical bills.”  Note that protecting the disabled are no longer part of the achievements.

I’m not sure why the discrepancy.  I can say that the second statement is far more accurate.  Due to Medicare’s cost-sharing—Medicare Part B, for instance, requires beneficiaries to pay 20 percent of the cost of most services—many disabled people on Medicare have trouble accessing care.  While many seniors have some sort of supplemental policy (often called “Medigap) that pays for most of the cost sharing, the disabled are often too poor to be able to afford monthly Medigap premiums.  Indeed, about 20 percent of the disabled on Medicare lack supplemental coverage as opposed to eight percent of seniors.

The data shows that the disabled on Medicare have a harder time paying for care.  Thirty-three percent of the disabled report major or minor problems paying for care versus about 13 percent of the elderly. A paper from the mid-1990s found nearly three times the number of disabled on Medicare reported not getting health care as the elderly.  Seventy-one percent of the disabled cited cost as the major factor.  Another study found that as a result of having higher rates of putting off or not getting care, the disabled experienced higher rates of stress and anxiety, physical pain, and the worsening of a medical condition or problems that eventually required medical attention.

None of these studies, naturally, appear in the Commonwealth Fund report.  I’ll have some more about how the disabled fare on Medicare Thursday, including what I think is the biggest problem most overlooked by health care researchers.

For now, you can read more about the disabled an Medicare in chapter 3 of my book, “Medicare’s Victims: How the U.S. Government’s Largest Health Care Program Harms Patient and Impairs Physicians.”  Here are the ordering options:

Paperback at, $14.99.

Kindle at, $6.99.

ePub at, $6.99.

ePub at iBookstore, $6.99.

I’d be remiss in not noting that Barnes & Noble is selling the paperback version for only $11.99.  The economist in me realizes that the 20 percent cut in price means demand for the book is lagging.  The writer in me can’t help but suffer a blow to his ego.


Medicare's Victims: Order Your Copy!

Finally!  Today is the official release of my book, Medicare’s Victims: How the U.S. Government’s Largest Health Care Program Harms Patients and Impairs Physicians!

It is available at, both paperback ($14.99) and Kindle ($6.99).

For those of you who have an eReader other than Kindle (i.e., it uses an ePub file) you can purchase the book at ($6.99).

UPDATE: It is also available at iBooks ($6.99).

I’ll be doing my first interview for the book today on the Bill LuMaye show, at about 3:15 Eastern time.

Finally, here are some excerpts from David Catron’s review of Medicare’s Victims at the American Spectator:

And what about the seniors who constitute the vast majority of Medicare beneficiaries? Surely, considering the enthusiasm with which single-payer advocates push Medicare-for-All, seniors fare better than the disabled. In fact, seniors endure countless hardships pursuant to the regulatory and reimbursement snarl in which they and their doctors find themselves immured by Medicare. It is in the care of seniors that the bureaucrats most brazenly substitute their judgment for that of health care professionals. The magnitude of this travesty is difficult to appreciate unless one has witnessed, as I have, a doctor violently slam down the phone after being told by Medicare that a septuagenarian suffering with congestive heart failure fails to “meet criteria” for an inpatient admission.

The perversity with which Medicare applies these criteria beggars belief. One of the stories Hogberg relates is that of a dialysis patient who had suffered kidney failure after a bout with cancer. He suddenly grew ill one morning and was rushed to a nearby ER where the doctors were informed in minute detail of his health status: “Frank needed dialysis, but under Medicare’s rules, he couldn’t receive it at a hospital unless he was an inpatient.” Like the patient noted above, he failed to “meet criteria.” Thus, he and his doctors were forced to wait until his condition deteriorated far enough to satisfy Medicare. At length he had a seizure, whereupon he was finally admitted and received dialysis: “Frank briefly recovered, but the damage was done.” Within a few months he died.

….Hogberg does not, however, despair of reforming the program. This brings us back to his proposal to give Medicare’s beneficiaries control over how the money is spent. Is it crazy to give Medicare funds directly to patients? Well, as Hogberg points out, this is precisely how Social Security works: “Beneficiaries receive their checks… each month and then have complete discretion over how to spend it.”

Hogberg would do away with Medicare parts A and B and replace them with “a Basic Account and a Major Medical Account.… The amount in these accounts will be renewed every year.” The idea is that beneficiaries should purchase health care the same way they buy other goods and services. The plan is obviously far too detailed to fully flesh out in this space, and any reform of Medicare has profound political implications, but Hogberg’s ideas are eminently sensible. Medicare’s Victims hits the shelves today. It’s well worth a read for anyone with a desire to understand how Medicare actually works.

Read it all.


Medicare and the Gila Monster Threat!

Apparently, the deadline to test the new ICD-10 system with Medicare has just passed.

If you’re wondering what “ICD-10” is, don’t worry …actually you should worry, for reasons I’ll explain in a bit.

Anyway, ICD stands for International Classification of Disease.  It is a system of diagnostic codes that physicians use to let Medicare and every other insurance provider know what the patient is being treated for. Depending on the diagnosis, ICD codes are from three to seven digits in length. So, if a physician sees a new patient and he diagnoses him with anemia, he would use the ICD code 280. If it is a more serious type of anemia, like Plummer-Vision Syndrome, the ICD code used would be 280.8.

The U.S. is still using ICD version 9, which has about 18,000 codes.  In October, the Centers for Medicare & Medicaid Services will switch over to ICD-10, which has about 80,000 codes.

If you think dealing with over four times as many codes is going to add considerably to the costs of running a physician’s practice, you’re right.  According to John Grimsley and John S. O’Shea, M.D. of the Heritage Foundation, “the potential cost of productivity loss [could] be anywhere from $8,500 to over $1.6 million per practice per annum…depending on practice size.” Of course—and here is why you should be concerned—the more resources that physicians have to spend dealing with codes mean less resources that will be spent treating patients.

While the cost of complying with ICD-10 will fall on all physicians, it is likely to fall hardest on primary care physicians, a topic I examine in my forthcoming book, Medicare’s Victims: How the U.S. Government’s Largest Health Care Program Harms Patients and Impairs Physicians. (“Squeezing every last bit of book promotion out of this blog, aren’t we?” — the Wife.) 

One of the physicians I interview, Dr. Juliette Madrigal-Dersch, explains it this way:

When you are a primary care physician, you are going to see a much wider variety of illnesses. If you are a specialist you are going to see a much more finite number of illnesses, especially if you are, say, an orthopedic surgeon who does primarily knees, probably 90 percent of all your codes are going to be the same five codes. As opposed to primary care, you never know what’s going to walk through the door. You could get something very rare. And now you have to be so specific with the codes. You have to code for “fall from uneven ground,” or “fall from tractor.”


Indeed, the ICD-10 codes have become something of a laughingstock.  If it can be coded, it probably is in ICD-10.  For example, there are codes for a bite from one of these guys:

The Gila Monster is found primarily in the Southwest United States and Mexico.  And there must be an epidemic of Gila Monster bites!  How else to explain the fact that there are 13 ICD-10 codes for having this guy clamp down on your hand?  Indeed, it is so serious that physicians may need to practice coding for Gila Monster bites.  One of the codes, T63.111, “should only be used for training or planning purposes.”

Here is a table listing the other 12 codes: 

This leads to a number of questions.  First, are there are lot of people who get bit by a Gila Monster more than once?  Second, is it correct in assuming that the “intentional self-harm” codes are there because a lot of people use this type of lizard to attempt suicide?  Finally, how do you assault someone with a Gila Monster?  I don’t know the answers to those questions, but I sure am glad that ICD-10 includes codes for them.

Now, here is the part where you come in.  ICD10Data is a search engine for ICD-10 codes.  I want you to go there, and type in any animal or object (like a lamp post or sink) that you can think of, and see if the ICD-10 has a code for it.  If it does, go back to the Facebook page that led you to this blog post, and in a comment tell me what animal or object you found a code for.

After all, what else are you going to do with your Fourth of July weekend?


Paid Parental Leave Shouldn't Be Mandatory

Should paid parental leave be mandatory in the United States?  Horace Cooper with the National Center for Public Policy Research and Elizabeth Peters with the Urban Institute discussed this issue on Al Jazeera America’s “Inside Story with Ray Suarez” on June 30, 2015.

“I’ve got no problem if an employer decides that a great way to retain employees for long term is to take [paid parental leave] on,” says Cooper. “I have a problem with, if that turns out not to be cost-effective for an employer, telling them, ‘You’re gonna do it anyway.’”


Donald Trump, the Clintons and Marijuana

How are Donald Trump, Bill and Hillary Clinton and marijuana linked to each other?

They were all topics of discussion June 28 on WHUT’s “New View with Ed Gordon,” and topics covered with zeal by our own adjunct fellow Horace Cooper.

Recent remarks by Donald Trump during his announcement of his presidential candidacy, considered by many to be racist and anti-immigrant, were played over and over again by the media. But Cooper questions whether the media is playing fair.

Bill and Hillary Clinton “honored and acknowledged Confederate Day for the eight years that they served as governor and first lady,” noted Cooper on public television’s “New View With Ed Gordon.” “Now, very little coverage of that. This, very prominent coverage. I find it curious.”

Also, in states where marijuana has been legalized, should employers be able to fire employees who use marijuana in their free time? Cooper says the issue comes down to whether the U.S. Supreme Court “is going to give us and recognize a constitutional right to use recreational drugs in our free time.” 


Earlier in the program, Cooper was adamant that people of all racial backgrounds need to be part of any healthy discussion about race.  He also discussed what the recent Supreme Court rulings say about the makeup of the Court.

“New York Times analysis of this [Supreme Court] term suggests that it may be among the most liberal… in about fifteen years.  Clearly a number of these decisions that came down aren’t going to comport with the the narrative that it’s a right-wing Court,” said Cooper.  “I want us to understand therefore that it’s not clear that just because someone was named by one president… that we know for sure how they are going to come down.” 


Medicare's Innovation Center Will Be Captured by Big Medical Providers

The Commonwealth Fund is publishing a series of papers this month under the heading “Medicare at 50 Years.”  Yesterday the Fund released a paper under this series entitled “Medicare Payment Reform: Aligning Incentives for Better Care.”  In it, the authors note that ObamaCare “has created the Center for Medicare and Medicaid Innovation, which is developing and testing new models to improve the quality of care provided to Medicare beneficiaries while reducing spending.”

The Center for Medicare and Medicaid Innovation (CMMI)—something created by ObamaCare—has a bevy of new “payment models” that it is trying on Medicare: the initiatives for Accountable Care Organizations which include the Pioneer Program and the Medicare Shares Savings Program; the Comprehensive Primary Care initiative; the Multi-Payer Advanced Primary Care Practice demonstration; and the Bundled Payments for Care Improvement initiative.

The results* of those programs are not particularly relevant to this post.  Rather, what is striking about the paper the Fund released yesterday is that there is not a hint of skepticism that a bureaucracy like CMMI is capable of innovating.  Indeed, they conclude that the “ultimate goal is to transform the delivery of care for everyone, improving patient outcomes and care experiences, preventing avoidable hospitalization, and lowering costs.

Here’s a more likely outcome: regulatory capture.  Regulatory capture “is the process by which regulatory agencies eventually come to be dominated by the very industries they were charged with regulating.”  

Over time, the bigger medical providers such as hospitals, skilled-nursing facilities, large physician practices—basically any group that can afford a lot of D.C. lobbyists—will begin making “proposals” for innovation that will benefit them while making it harder for their smaller competitors to survive.  The bureaucrats who work at CMMI will be all too happy to accommodate the big medical providers because they will be accommodating their future employers. The people at CMMI will develop knowledge and skills that will be very helpful to big medical providers wanting to get their proposals accepted by CMMI.  And, of course, the big medical providers will pay much better than the government.

The end result will be one that stifles innovation.  As John Goodman states in his book Priceless:

Successful innovations are produced by entrepreneurs, challenging conventional thinking—not by bureaucrats trying to implement conventional thinking. There are lots of examples of successful entrepreneurship in healthcare. There are very few examples of successful bureaucracy. Can you think of any other market where the buyers of a product are trying to tell the sellers how to efficiently produce it?

Any upstart medical provider who has developed a more cost-effective way to treat patients—and one that threatens the way the big medical providers do things—will likely never see his idea adopted by CMMI.  The big medical providers will use their clout with CMMI to stymie it.

My forthcoming book, Medicare’s Victims, contains an example like this.  Chapter 9, titled “The Big Hospital Lobby” examines how general hospitals used their clout with Congress to stop the spread of smaller physician-owned specialty hospitals. Some excerpts of that chapter can be found at the Atlas Society’s website.

In the long run, the CMMI will become an agency dedicated to preserving the status-quo in Medicare.  True innovators will need not apply.

*The Accountable Care Initiatives have had, at best, mixed success so far, while the Comprehensive Primary Care Initiative has failed to achieve any significant cost savings or quality improvement.  The other programs are too young to have any measurable results.  

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