Libertarian Perspectives

A Blog By Kurt Johnson

Wellmark right to disclose cost of anonymous patient

The Des Moines Register recently reported that Wellmark Blue Cross Blue Shield has been accused of violating federal HIPAA privacy regulations in the case of a patient with severe hemophilia.  (See link to Register article below.)  As reported, a representative of Wellmark was discussing the high cost of health insurance at a Rotary Club meeting last March.  She gave an example of an extreme case that was costing $1 million per month.  (ACA – Obamacare – prohibits insurance companies from placing any limit on the amount it will pay for patients.)  She did not identify the patient by name, but described him as a 17 year old male with hemophilia.  Maybe she should not have mentioned the age or sex of the patient, but that information alone did not identify who the specific patient was, and should not be considered a violation of federal privacy regulations.

Wellmark and other insurance companies must be able to cite specific high cost cases that are causing health insurance premiums to rise to unaffordable amounts.  How can we openly debate ways to contain health care costs if we don’t know what is causing the high costs?  Can we really afford to require insurance companies to pay out unlimited amounts for any patient?  I recently heard that the last remaining company to offer individual health insurance policies in Iowa may charge more than $30,000 per year next year for a couple who are 55 years old.  Health care wants are unlimited.  Our ability to pay is not.  We need to debate whether or not government should prohibit health insurance policies from having limits on how much they pay out for individual patients.

Link to Register article: http://www.desmoinesregister.com/story/news/health/2017/08/21/wellmark-accused-violating-privacy-iowa-teen-severe-hemophilia-reportedly-costing-1-million-month/586702001/

 

 

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Transgendered okay in the military, but sex change surgery should not be paid for by taxpayers.

A transgendered person should be eligible to serve in the military, just like just like every other man or women, and just like every other gay or straight person.  If they are qualified to do the job, then government should not discriminate against them based on their transgendered status.  That does not mean the military or taxpayers should foot the bill for sex change operations.  Just as being transgendered is not a disease, surgery to to change a person’s sex is not a medical necessity.  Transgendered folks will can be completely healthy without a sex change operation.  So, sex change operations should be considered elective, and not be required to be covered by any insurance plan, including that of the military.

Unlimited cost of care under the ACA health insurance policies?

In The Des Moines Regiser’s report about Wellmark getting out of the health insurance market for individual policies under the Affordable Care Act (ACA), they reported, “Forsythe (CEO of Wellmark) cited a single Wellmark customer who has a rare genetic disease that is costing more than $1 million per month to treat.” One person – A million dollars a month.  (See link to article below.)
One of the fatal provision of the ACA is the requirement that there be no limit in health insurance policies on how much can be paid for any individual’s care. No limit. Should we really expect others (society) to pay a million dollars a month for the care of ourselves or our family members? If you help to pay that much for someone else, then won’t you expect the same to be paid for you if you have the need? How can that be sustainable? Who gets to makes decisions regarding who we pay for and who we don’t? Unfortunate as it may be, it is a reality of life that we cannot afford, even as a society, to pay for everything we want. To the extent that those decisions, including limits on health insurance policies, can be made privately and voluntarily, we will have a more just, civil, and sustainable society.

EpiPens and Government Cheese – article from Reason Magazine

The November issue of Reason magazine included the article below by Katherine Mangu-Ward.  I think it is an excellent example of how our government can screw things ups, no matter how good the intentions.

 

EpiPens and Government Cheese

Some things won’t change no matter who wins the 2016 election.

At the end of August, the U.S. Department of Agriculture bought 11 million pounds of cheese—that’s a cheese cube for every man, woman, and child in America—in order to bail out the nation’s feckless cheesemongers.

Secretary of Agriculture Tom Vilsack touted the aid package, worth $20 million, as a win-win: “This commodity purchase is part of a robust, comprehensive safety net that will help reduce a cheese surplus that is at a 30-year high while, at the same time, moving a high-protein food to the tables of those most in need.” (Most of the federal government’s new stockpile will go to food banks.)

This bailout of Big Cheese came on top of an $11.2 million infusion earlier in the month to dairy farmers enrolled in a 2014 federal financial aid scheme. The deal comes after months of lobbying by the National Farmers Union, the American Farm Bureau, and the National Milk Producers Federation, who were too antsy to wait for their next big cash cow to come ambling in with the farm bill.

The same week, Sen. Chuck Grassley (R–Iowa) wrote a letter to the pharmaceutical company Mylan, demanding an explanation for why EpiPens, the epinephrine auto-injectors that severely allergic people carry in case of an emergency, have quadrupled in price since 2007. Grassley cited constituents paying $500 to fill their prescriptions.

Hillary Clinton issued a statement about the price increases as well: “Since there is no apparent justification in this case, I am calling on Mylan to immediately reduce the price of EpiPens.” Donald Trump used the occasion to score points, tweeting out a story about hundreds of thousands of dollars in donations to the Clinton Foundation from the disgraced company. Sen. Amy Klobuchar (D–Minn.) echoed Clinton’s sentiment in a letter to the Federal Trade Commission: Lamenting that “antitrust laws do not prohibit price gouging,” she asked the regulatory body to look into whether Mylan has used “unreasonable restraints of trade” to keep prices high.

The summer’s cheese bailout and EpiPen price scandal are ideological Rorschach blots.Where one observer sees only the evils of the profit motive, another looks at the same fact pattern and sees the perils of an overweening regulatory state.

Vox sided solidly with the profit shamers, declaring: “We are the only developed nation that lets drugmakers set their own prices, maximizing profits the same way sellers of chairs, mugs, shoes, or any other manufactured goods would.” But pseudonymous blogger Scott Alexander of Slate Star Codex responded with a tidy reverse Voxsplanation: The cronyist Food and Drug Administration (FDA) and other government forces have squelched nearly every effort to compete with Mylan’s EpiPens, distorting the market beyond recognition via a process he chronicles in painful detail.

Mylan acquired the EpiPen from Merck in 2007, by which time the product was already 25 years old, which means the question of paying back research costs was moot. In 2009, Teva Pharmaceuticals tried to enter the market—and Mylan sued. Teva managed to get its product to the FDA anyway, only to be told that it had “certain major deficiencies,” unspecified. In 2010, Sandoz Inc. tried its luck and got bogged down in the courts, where the case still dwells. In 2011, the French drug company Sanofi made a bid to gain approval for a generic, which was delayed for years because the FDA didn’t like the proposed brand name. Which brings us to this year, when Adamis decided to sell plain old pre-filled epinephrine syringes directly to patients without the fancy injector. Cue an FDA recall, on the rather vague basis that insufficient study had been done on standard administration of a drug whose medical properties have been known since the turn of the last century.

And sometimes the tangled, dysfunctional relationship between big business and big government gets even more personal. The CEO of Mylan, Heather Bresch, is the daughter of U.S. Sen. Joe Manchin (D–W. Va.), which probably makes things awkward in the Senate cafeteria. But Manchin has joined his colleagues in saying that he is “concerned about the high prices of prescription drugs,” which probably makes things awkward at Thanksgiving. Then again, Mylan spends over a million dollars a year lobbying, which likely goes a long way toward smoothing things over.

In 2014 Congress passed the School Access to Emergency Epinephrine Act, which Grassley mentions in his letter. The law, he writes, “provides an incentive to states to boost the stockpile of epinephrine at schools.” It was co-sponsored by Klobuchar, the same senator who now wants to sic the antitrust dogs on Mylan. That law was a top lobbying priority for Mylan that year, along with new rules that reduced competition for generics.

Grassley also notes that the taxpayers are picking up the tab for kids who are getting EpiPens while on Medicaid or the state-level Children’s Health Insurance Program, and he adds that some 47 states require or encourage schools and other public institutions to stock EpiPens. In other words, Congress created a huge new class of price-insensitive EpiPen customers and now wonders why the price has gone up.

Meanwhile, the prescription laws still require you to get a special piece of paper from a doctor every single time you want to buy an EpiPen. If the doctor writes a brand name on that paper, it’s illegal for the pharmacist to give you a cheaper generic.

The story of the government cheese is just as convoluted. It’s easy to be lulled by Vilsack’s sell: Helping farmers and the hungry? Sounds great! But you know what else helps move a glut of cheese off the shelves and into the hands of poor people, without requiring taxpayer dollars? Lowering the price.

That’s something the industry isn’t willing to do, and—given all the pricing rules and production quotas that have been distorting dairy markets since the 1930s—mostly can’t do. With Americans eating a record 34 pounds of cheese a year, the problem isn’t an unexpected drop in demand.The problem is a failure to allow the laws of supply and demand to function at all.

Eleven million pounds of cheese may seem like small potatoes (to mix culinary metaphors), and it is in the larger scheme of federal spending and meddling. What’s another $20 million when the debt is already $20 trillion, after all? But our typically cheerful acceptance of central control of compressed curds and injectable epinephrine shows how widespread and insidious such conditions are in our lives.

What would real free market reforms look like, and how would they come about? In this issue, you’ll read what Libertarian Party nominees Gary Johnson and Bill Weld would do in the (very unlikely) event that they won the presidency and vice presidency (page 30). Reason TV’s Jim Epstein reports on the millennial libertarian activists in Brazil who brought down a corrupt populist president (page 50). And in Detroit, an American city where public services are essentially nonexistent, we detail how residents are building DIY alternatives (page 65).

In the meantime, there is no reason to think either the tale of the EpiPens or the saga of the cheese would play out any differently under President Trump or President Clinton. Taxpayer-funded sops to farmers are as bipartisan as it gets, and there is precisely zero chance that a president from either major party would discontinue the practice. Likewise, the iron grip of the FDA on the drug approval process—and the opportunities to purchase influence in that powerful bureaucracy—will not diminish one iota, regardless of which major-party candidate becomes America’s Big Cheese in January.

EpiPen fiasco was caused by the FDA – don’t blame free market capitalism

Our government, not free market capitalism, is to blame for this situation which has allowed Mylan Pharmaceutical company to jack-up prices for its EpiPen. The FDA is has created a huge delay in approving generic epipens.  This has effectively given Mylan a monopoly.  Established drug companies should have some type of fast-track authority to manufacture generic products without having to get advance approval from the FDA.  Don’t blame private enterprise for problems created by government.

How to lie with statistics – Iowa Medicaid bids

Today, The Des Moines Sunday Register reported that the bids of the insurance companies that were chosen to manage Iowa’s Medicaid program contained misleading and unverifiable data.  (See link below.)
One example you cited was from UnitedHealthcare’s bid, where they stated that their Kansas affiliate reduced premature births by 23 percent from 2013 to 2014.  Although it is possible that the efforts by UnitedHealthcare caused this result, it is also possible that the result were caused by random fluctuation.
If you measure 100 health indicators, and the results follow a statistically normal distribution, then a few of the indicators will show significant improvement and a few will show significant worsening, even though there is no real change in long term trends.
It’s just like if you asked 100 investors to each pick a group of stocks by throwing darts at a stock listing.  A few would make amazing gains and a few would suffer tremendous losses – none of which could be attributed to the ability of the investor.

In the bids by the insurance companies, all they had to do was “cherry pick” the best statistics after the fact to make themselves look good.  So, while the statistics my be true, they are clearly misleading.

Link: http://www.desmoinesregister.com/story/news/investigations/2015/11/07/medicaid-bids-include-misleading-unverifiable-data/74233238/

Supreme court was wrong on Obamacare!

I will respect the ruling of the Supreme Court in upholding the subsidies under Obamacare, but the decision was wrong.

Those who drafted, supported, and voted for Obama care clearly intended to withhold money from those states that did not set up their own state health insurance exchange – just like many other laws that require states to meet certain requirements in order to get federal money.  In this case, they intentionally wrote the law to provide subsidies only to people in states who purchased their health insurance through an “exchange established by the state.”  It was intended as a carrot or a stick to get the states to comply.  Many did not comply, so the strategy backfired.

The job of the Supreme Court is to resolve disputes based on the law, the facts, and the Constitution.  It is not the job of the Court to fix mistakes in political strategy.  That is what they did, and it was wrong.