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Regulators > suppliers

North Carolina’s infinitely wise and all-knowing medical facilities regulators have decided that Wake County, which includes  two of the state’s ten largest cities, has need for three more operating rooms this year. Four hospitals have plans to build a total of nine new operating rooms. But the state is confident that its certificate of need (CON) procedure will reduce costs by reducing proposed supply by one-third.

You don’t need dentists for dental care

Sarah Avery at the Raleigh News & Observer has a terrific story this morning on ideas from dentists and dental hygienists that could improve access to dental care throughout the state without creating a new government program or spending another tax dollar.

Dentist Steven Slott wants to create a sub-dentist “mid-level worker” and dental hygienist wants to create a “superhygienist,” but the idea in both cases is the same: somebody in the dental field who is trained to do more than clean teeth but less than root canals, like a nurse practitioner.

I hope we can build support for both ideas. Too many people in the state have little access to dental care. Dentists cannot afford to be everywhere. Dental hygienists are not allowed to work on their own. The state needs to ease the restrictions on practice and licensing.

This new model is not a threat to dentists, but an opportunity for those without access to care.

Re: COBRA’s bite

John,

Thanks for highlighting John Hood’s column this morning. When people who purchase insurance on their own become unemployed, they are three times as likely to remain insured than those who were insured through their employers, even with COBRA. But COBRA is expensive and entails a big jump in premiums, so just 19 percent of unemployed people had purchased coverage that way. Federal subsidies doubled the percentage of unemployed taking up the continuation of coverage benefit as they cut the cost to individuals by 65 percent. As noted, COBRA is a bad idea, with or without subsidies.

Recent research goes further still, and questions the value of group insurance. The authors find that benefits from individually-based insurance more than offset any cost savings from getting insurance in a group plan.

Individual policies provide more choice, more security, and cost less for the unemployed without raising cost to taxpayers. Why do Republicans and Democrats alike want to build on the current employer-based system?

cross posted at Locker Room

It pays to pay for care

Before Canadians could legally pay for private medical care, they were stuck on waiting lists until their condition became dire. Americans on Medicare, in contrast, used their income to pay for specialist visits when they felt a need.

That is not the conclusion of a paper in the January 2010 International Journal of Health Services, a publication more driven by political beliefs than by facts, or of a prominent progressive in North Carolina, but it is a logical conclusion from the findings.

The study used data from a 2002-2003 health survey. Canada’s Supreme Court did not strike down provincial government-run health insurance monopolies until 2005. So Canadians age 65 and older had to go on a waiting list instead of seeing a specialist. As Sally Pipes explained, her mother died in Canada because it took too long to get the care she needed for her colon cancer.

That is why North Carolina should follow the lead of Arizona and protect our freedom of health care choice.

Crossposted at johnlocke.org

We need more ORs, we have too many, we need more

The one good thing about North Carolina’s efforts to control medical capital investment is that they don’t create five-year plans. In 2008, regulators thought Wake County (Raleigh and Cary, NC) needed four operating rooms (ORs). By the time they granted approval to a hospital and orthopedic center in 2009, state regulators said the county had too many ORs. For 2010, they now say Wake County needs three more ORs, plus another two for somewhere in the Wake-Orange-Durham Triangle area.

The Left’s two health care bets

Folks on the Left are excited because they believe Harry Care would not just, as John Goodman wrote, nationalize health insurance and eliminate future attempts to reform health care with markets, but would become more popular and a political winner. John Hood remains unconvinced that the bets are good ones. I would rather not find out.

Even Bob Herbert gets it

Bob Herbert has discovered that the so-called Cadillac Tax, which Jonathan Gruber refuses to even acknowledge is a tax (it only removes a tax exemption after all), will hit the middle class.

Proponents of the tax use arguments that sound a lot like the pro-market ideas they oppose. Herbert summarizes their claim: “If policyholders have to pay more out of their own pockets, they will be more careful — that is to say, more reluctant — to access health services.” The Joint Commission on Taxation expects most of the money, “82 percent of it, will come from the income taxes paid by workers who have been given pay raises by employers who will have voluntarily handed over the money they saved by offering their employees less valuable health insurance plans.”

AFL-CIO President Richard Trumka is incredulous that employers would offer higher pay to their workers. If the JCT argues that all of the forgone insurance premiums will translate dollar for dollar into higher pay, that claim does defy credulity. Companies would likely convert some of the savings into lower prices for customers or another valuable purpose – not simply to higher profits as union bosses claim.

Herbert, who has long criticized the president’s focus on health care instead of jobs, is right when he states, “The tax on health benefits is being sold to the public dishonestly as something that will affect only the rich, and it makes a mockery of President Obama’s repeated pledge that if you like the health coverage you have now, you can keep it. Those who believe this is a good idea should at least have the courage to be straight about it with the American people.”

Instead of an honest, open debate, we got a Senate bill at the last minute that was drafted to get votes even if one part of the bill conflicts with another part. The conference bill will be crafted in the West Wing of the White House, though still with no cameras and likely no more sense of what is in it until months or years later as it takes effect.

Medicaid overmedicates poor kids

As Congress continues to debate the brave new world of health care, the New York Times provides an example from Health Affairs of government-run health care’s predisposition for prescriptions.

New federally financed drug research reveals a stark disparity: children covered by Medicaid are given powerful antipsychotic medicines at a rate four times higher than children whose parents have private insurance. And the Medicaid children are more likely to receive the drugs for less severe conditions than their middle-class counterparts, the data shows.

Reporter Duff Wilson provides a look at the debate over treatment of low-income children with mental or behavioral problems. Meicaid pays less for counseling or psychotherapy, but charges no copays for prescriptions. Unless the parent has an aversion to medicating her child, the easiest and cheapest solution is to take the prescription.

Medicaid children are also 50 percent more likely to be diagnosed for attention deficit, hyperactivity disorder (ADHD) than those with private insurance. The condescension towards the children on Medicaid is palpable among some doctors:

“Maybe Medicaid kids are getting better treatment,” said Dr. Gabrielle Carlson, a child psychiatrist and professor at the Stony Brook School of Medicine. “If it helps keep them in school, maybe it’s not so bad.”

Comparative effectiveness research and evidence-based medicine are worthwhile when setting voluntary standards. But the research moves too much and is too unsettled to apply with authority through law or regulation.

Cross-posted at LockerRoom

High-risk insurance pools

When North Carolina passed its high-risk insurance pool, the legislature managed to do it without raising taxes and with the inclusion of high-deductible, HSA-eligible insurance options. The high-risk pool started enrolling people this year. It still makes more sense than regulating how insurance companies price their policies, but should be seen as a transitional product until we have consumer-driven markets. I made these points in an interview with Carolina Journal Radio. You can read the transcript here.

Is market power bad for insurance companies?

John Buntin at Governing.com compared health insurance premium increases in various states with the the market concentration among insurers and found … higher concentration meant lower premium increases.