Author Archive:

Rituparna Basu

Rituparna Basu

Rituparna Basu is a Writer and Research Associate at ARI, focusing on health care policy issues. Her op-eds have appeared in such venues as TownHall.com and the Daily Caller. She is a frequent speaker on college campuses across America.

Health Care in Headlines [#01]

Monday, May 20, 2013 by Rituparna Basu

Here is a roundup of some recent health care items making headlines, with my comments:.

  • Obamacare “scares the daylights out of” small businesses, who, through a crippling new tax, will be forced to pay the medical bills of others.
  • Last fall one compounding pharmacy made headlines when steroid injections it sold caused a meningitis outbreak. Now the FDA wants to control all compounding pharmacies. Whatever happened to being treated as innocent until proven guilty?
  • Grocery stores will have to spend $1 billion in the first year alone to meet Obamacare’s requirement of displaying calorie labels on all their foods. Says one executive at Kroger, “We might have thousands of SKUs for birthday cakes and thousands of types of prepared pizza. The problem is [Obamacare] forces us to label all of that, down to the olive bars and salad bars.” Much of the cost will go towards not signage but just figuring out how many calories are in each food item they sell.
  • Last week Obama addressed concerns over the “train wreck” that is expected from implementing Obamacare, saying, “We still have a lot of work to do in the coming months to make sure more Americans can buy affordable health coverage.” One crucial task is convincing young people to sign up for insurance (in order to fleece them to pay for the medical bills of others). Look out this summer for a mass marketing effort in this vein.

Tags: , ,

Posted in Government & Policy

Send a comment to the author

The Obamacare train wreck shouldn’t be ignored

Friday, May 10, 2013 by Rituparna Basu

4515656569_19c6697c7d_bIt seems indisputable by now that Obamacare will wreak havoc on the American health care system. Even Sen. Max Baucus, an architect of the law, recently predicted that implementing Obamacare will be a “huge train wreck.”

Curiously, this news has evoked not much more than a shrug from some people. For example, New York Times columnist David Brooks dryly summarizes the disasters expected to occur (“chaos” that will unfold in “cascades”) and then chalks it up to: “When you build [a] complex [regulatory regime], it takes a while to work through the consequences.” (Brooks is more interested in the political ramifications of Obamacare’s failure than its effects on people.)

But the damage that Obamacare will inflict on American health care—and as a result, on all of us—is not something to dismiss so nonchalantly. Brooks suggests that the pain may be temporary and eventually things will “settle down to a new normal.” Even if this were true (it isn’t—the “new normal” will be a health care system permanently crippled by greater government control—read one example here), Obamacare’s consequences should not be minimized.

The law will severely alter people’s lives—and not for the better. Here are just a few recent news headlines:

These consequences, far from being shrugged off, should call into question the goal and rationale of the law itself.

Photo Credit: Free 2 Be via Compfight cc

Tags: , , ,

Posted in Government & Policy

Send a comment to the author

Any way you slice it, Obamacare fleeces some to pay the medical bills of others

Thursday, May 9, 2013 by Rituparna Basu

3466862143_c9005b6fdd_bObamacare requires young people to pay higher health insurance premiums in order to subsidize older people’s coverage. But don’t worry, say Obamacare’s defenders: Many young people will qualify for federal subsidies to offset the higher premiums. For example, health policy analyst Austin Frakt says, “[M]ost of the cross subsidization is not flowing from younger to older individuals. It’s flowing from the treasury to everyone with low enough incomes.”

This defense doesn’t hold water.

First, only those earning below 400% of the federal poverty level are eligible for subsidies, which means if you are a young single worker who makes more than $45,960 a year, you must pay the higher premiums imposed by Obamacare entirely out of your own pocket. In my view, even one young person fleeced to pay for the older generation’s health care expenses is too many.

Second, the government obtains money for the promised subsidies by confiscating funds from its citizens—in the form of taxes, borrowing, or printing money (this last effectively depletes savings). So when Frakt says the federal government will effectively be subsidizing the coverage of those older, what he means is that everyone (including young people) whose earnings are drained by the government will pay for the coverage of those older. But it’s wrong for the government to force any group of people—be they young, of higher-income, or classified by any other category—to pay the medical bills of others.

Photo Credit: herzogbr via Compfight cc

Tags: , ,

Posted in Government & Policy

Send a comment to the author

Don’t drug companies have rights?

Wednesday, May 8, 2013 by Rituparna Basu

7637352_78d9d02e5d_bIn a recent op-ed Judith Stein of the Center for Medicare Advocacy explains why she thinks government should lower drug prices for Medicare recipients. The article is worth reading because it is an example of a pernicious assumption that permeates most health policy discussions.

Stein argues at length that lower drug prices would benefit Medicare recipients, the federal government and taxpayers. Considered out of context, who could oppose the possibility of cheaper life-saving drugs for the elderly?

But consider the means Stein supports to bring about this result—a congressional initiative to impose price controls on drug companies (a process dressed up by calling it a “rebate”).

By what right does the government dictate to drug companies—those who have spent billions of dollars and worked countless years to figure out how to alleviate the complex ills that can plague the human body—what they can charge for their efforts? Stein doesn’t bother to consider this issue in her article—the assumption is that since some people need cheaper drugs, it’s okay to pay the producers, not what they’re charging, but what the consumers decide is enough.

Imagine doing this in any other context—for example, walking into an Apple store, picking up an iPad that costs $499, deciding it’s not worth that much, slapping a hundred dollar bill on the counter and walking out. It would be inconceivable (not to mention a crime).

Yet this attitude is ever-present in health policy circles, where there is much discussion about how to distribute the efforts of others without any consideration of the rights of the producers. In this case, there is no consideration for the fact that these drugs belong to the companies that have invested the time and resources to produce them—and that nobody else has the right to decide the price at which they are sold.

Photo Credit: selva via Compfight cc

Tags: ,

Posted in Government & Policy

Send a comment to the author

What would American health care look like if the government didn’t control it?

Tuesday, April 30, 2013 by Rituparna Basu

6869336880_31ae61b74a_bAlmost 50% of all health care dollars in the United States are spent by the government, and the other half is spent by private insurers and individuals on a market that is heavily regulated and controlled by government.

What might medicine look like if government weren’t so deeply entrenched in it? It can be a tough thing to imagine, since government and medicine have been “joined at the hip” (to borrow a recent phrase from Obama) for more than half a century.

There are some Americans, however, who have lived long enough to remember the state of medicine when it was freer. In a recent op-ed in the Wall Street Journal, a doctor describes how his experience in medicine dramatically changed over the course of his medical career—and not for the better. Dr. Marsh says:

When I graduated from medical school in 1962, the profession of medicine was for many graduates an opportunity to provide care—as distinguished from, though aligned with, treatment—and to provide it to individuals, not to populations or governmentally specified groups. Young doctors hoped to establish an independent business, enjoy lifelong intellectual excitement as knowledge and therapies expanded, and have an income sufficient to live decently and support a family….

After eight years of postgraduate study, I opened a solo pediatrics practice in a community of 10,000 souls an hour from Boston. A number of lean years passed before I could build a robust practice. Yet the experience was exactly what I—and I think many of my colleagues—sought: a personal, direct and unimpeded relationship between me and those who chose to become my patients….

I had to give my acute attention to the price of every medical intervention. The costs could have a direct and painful impact on a family’s budget. So I had to know the prices for most of the medications I prescribed and of most of the tests I might order. I learned to play for time by waiting, when it was safe to, before ordering an X-ray or a test—and to substitute less-expensive medications for more costly ones wherever possible….

Then, in the mid-1970s, things changed, and we became enlightened. Third parties, typically the insurance companies, were interpolated between the physician and the patient. Some of the consequences were unfortunate….

Physician compensation is tied to “efficiencies,” which means reducing the outlays and costs to the group (translation: skimp where possible) and thus generating for internal distribution a larger share of the prepaid premiums….

Insurance relationships drove practice relationships.

What Dr. Marsh is referring to is the rise of HMOs in the 1970s, propped up by government subsidy. He describes how these government-bred entities transformed his relationship with patients from one in which their interests were aligned (the better care he took of his patients, the greater rewards he received) to one in which doctors had incentives to sacrifice the quality of patient care to pad their pockets. The whole editorial is worth reading.

Dr. Marsh describes how the quality of medicine fell as government intruded further in health care. His observations suggest that medicine would look radically better if it were completely unchained from government control, especially considering the remarkable technological advancements made in the last fifty years.

Photo Credit: Alex E. Proimos via Compfight cc

Tags: ,

Posted in Government & Policy

Send a comment to the author

Topix.com: How Obamacare Fleeces the Young

Friday, April 26, 2013 by Rituparna Basu

I have an op-ed today on Topix.com’s Politix page about Obamacare’s age-related rate restrictions, which require younger people to pay higher insurance premiums in order to subsidize the coverage of those older. I say in the article:

No one, presumably, would be comfortable with the idea of fleecing our children and grandchildren in order to lighten our bills. But supporters of the Affordable Care Act have taken to arguing that forcing young people to subsidize older people isn’t some new consequence of the health law—all insurance, they claim, requires some people to subsidize the expenses of others. Take fire insurance. Ten thousand people might sign up to insure their homes, but only a couple of those homes may end up burning down. The premiums paid by those whose homes did not burn down go toward rebuilding the homes of those whose did.

“That’s how insurance works,” insists health policy analyst Aaron Carroll, who concludes that the health law’s age-related rate restriction is “really not much different than how insurance is supposed to function, by transferring money from the more-healthy to the more-ill.”

But by equating traditional insurance with the health law’s age-related rate restriction, commentators like Carroll ignore a key component of insurance in a market absent government intrusion: the freedom to buy a policy that is priced according to your own risk—a policy that subsidizes no one.

Check out the whole article here. I previously addressed another argument made by proponents of this restriction, here.

Tags: , ,

Posted in Business & Economics, Government & Policy

Send a comment to the author

What Americans can learn from the flawed battle against socialized medicine in Canada

Thursday, April 25, 2013 by Rituparna Basu

2076448655_6e428847e7_oIn my recent interview with Sally Pipes about Canadian health care, we discussed how Canada succumbed to socialized medicine. According to Ms. Pipes, calls for government-provided health care began in the province of Saskatchewan in the 1940s. The discussion brought to mind Ayn Rand’s own comments on the events in Saskatchewan, which she gave in a talk to doctors in 1963 (“How Not to Fight Against Socialized Medicine”). Her comments remain applicable to the fight for freedom in medicine in America today.

The day socialized medicine went into effect in Saskatchewan in 1962, the doctors in the province went on strike. But though “right [was] on their side,” and though they had the “overwhelming sympathy and support of the Canadian people,” the doctors quickly surrendered. “They were defeated,” according to Rand, “not by the power of the socialists, but by the gaping holes in their own ideological armor.”

Said Rand:

[The doctors] had been fighting, properly, in the name of individual rights, against the enslavement of medicine by totalitarian-statist controls. Then, under the pressure of the usual intellectual lynching, under the hysterical, collectivist charges of “anti-social selfishness and greed,” they made a shocking change in their stand. Declaring, in effect, that their rebellion was not directed against socialized medicine as such, but against the high-handed, arbitrary manner in which the government had put it over, their spokesmen began to argue that the government plan did not represent “the will of the people.” The ideological kiss of death was a statement by Dr. Dalgleish, the strikers’ leader, who declared that if a plebiscite were taken and the people voted for it, the doctors would accept socialized medicine.

Could they deserve to win, after that? They could not and did not.

Consider the full meaning of Dr. Dalgleish’s statement. It meant the total repudiation of individual rights and the acceptance of unlimited majority rule, of the collectivist doctrine that the people’s vote may dispose of an individual in any way it pleases. Instead of a battle for the integrity of a doctor’s professional judgment and practice, it became a battle over who should violate his integrity. Instead of a battle against the enslavement of medicine, it became a battle over who should enslave it. Instead of a battle for freedom, it became a battle over a choice of masters. Instead of a moral crusade, it became a petty quarrel over political technicalities…

[T]he doctors’ surrender took place five days after Dr. Dalgleish’s statement.

The text of the agreement reached between the doctors and the government, contained the following horrifying sentence: “The doctors fear that if the government becomes their only source of income they are in danger of becoming servants of the state and not servants of their patients.” [Italics are Rand’s]

According to Rand, such a defense actually works in the favor of the proponents of socialized medicine. “[I]f ‘service’ to the [patients] is our primary goal,” she pointed out, “why should these masters pay us or grant us any rights? Why shouldn’t they dictate the terms and conditions of our work?”

What the doctors in Saskatchewan were missing was the confident moral assertion of their own rights. Rand put it as such:

The pursuit of his own productive career is—and, morally, should be—the primary goal of a doctor’s work, as it is the primary goal of any self-respecting, productive man. But there is no clash of interests among rational men in a free society and there is no clash of interests between doctors and patients. In pursuing his own career, a doctor does have to do his best for the welfare of his patients. This relationship, however, cannot be reversed: one cannot sacrifice the doctor’s interests, desires and freedom to whatever the patients (or their politicians) might deem to be their own “welfare….”

Many doctors know this, but are afraid to assert their rights, because they dare not challenge the morality of altruism, neither in the public’s mind nor in their own.

Such moral confidence continues to be largely absent in the health care debate today. For example, consider this statement by Docs 4 Patient Care (a doctors’ organization committed to fighting Obamacare), found in their “prescription for reform”:

Docs 4 Patient Care is an organization of physicians dedicated to the preservation of the doctor-patient relationship….Our primary concern is the health and well-being of our patients. An additional concern is the health and well-being of our country—physically and financially.

Those are certainly legitimate concerns, but what about the concern that government intrusion in medicine violates a doctor’s right to practice medicine as he sees fit? There is no mention of this in D4PC’s document (despite the good work they otherwise do). The fight for freedom in medicine would certainly be strengthened with its inclusion.

Photo Credit: abdallahh via Compfight cc

Tags: , ,

Posted in Government & Policy

Send a comment to the author

What’s too often missing from the health care debate

Wednesday, April 17, 2013 by Rituparna Basu

Welcome_to_VermontA recent editorial in the New England Journal of Medicine discusses Vermont’s single-payer health care system and makes the case that other states have a lot to learn from the Green Mountain State. What struck me was what the piece left out of its discussion.

Here are the alleged positives of socialized medicine in Vermont, according to the article:

  • “Transparency” and the “engagement of all stakeholders”
  • An “independent” five-member board that controls every price, every product and every medical provider
  • A state-run health insurance market
  • Cost savings

If you needed heart surgery and were considering where to have it, and somebody handed you this list of the benefits of Vermont’s scheme, my guess is you’d toss the list aside and ask, “But are there surgeons in Vermont who have a higher success rate for my particular surgery than those in other states? What are their protocols for reducing medical errors? Are they particularly good at dealing with complications that might arise when I’m on the table?”

There is no mention of the quality of health care in Vermont in the NEJM article, and this article is not an exception—it is all too common for discussions of greater government intrusion in health care to proceed without any consideration for what this will mean for the quality of care available.

The reason there is such little concern with the quality of care is that the leading advocates of government control over the medical field are motivated by egalitarianism—the notion that everybody should have equal health care, even if that care is equally shoddy. To learn about the quality of health care that ultimately results from such an approach, you need only listen to the recent interview I conducted with Sally Pipes, in which she discusses her harrowing firsthand experience of socialized medicine in Canada. (Though Vermont’s scheme is relatively new, there’s reason to expect the same kind of downward trend in quality.)

If advocates of increasing government control were motivated by making possible the highest quality health care, they would talk more about the indisputable fact that freedom and free markets were essential preconditions for the unprecedented human advancements of the last 150 years, including in medicine.

Image: Wikimedia Commons

Tags: , ,

Posted in Government & Policy

Send a comment to the author

The Obama Administration thinks more expensive premiums are good for you

Wednesday, April 10, 2013 by Rituparna Basu

Health_insurance_reform_bill_signature_20100323Recently the Obama administration finally acknowledged what everybody else already knew—Obamacare is going to send premiums through the roof.

How do you defend a reality (e.g., 27-year-old males will see premiums rise by 189%) that you not so long ago insisted was fiction (“My health care bill will cut the typical family’s insurance premiums by up to $2,500”)? One way is by playing the “Yeah, but this is better for you” card.

That was basically the approach taken by Kathleen Sebelius, secretary of the Department of Health and Human Services, when she addressed reporters the other day. Sebelius insisted that people “are going to see much better benefit for the money that they’re spending.”

In other words, if you’re a 27-year-old who is forced to shell out three times as much for premiums next year in order to, as Obamacare requires, foot the medical bills of 55-year-olds, according to Sebelius you’re better off. If you’re a male who must now, as Obamacare mandates, buy coverage for services you’ll never use, such as contraception, breast pumps and in vitro fertilization, according to Sebelius you’re better off. If you prefer a low-deductible policy that offers only catastrophic coverage, yet Obamacare makes such a policy illegal to sell, according to Sebelius you’re better off.

This paternalistic attitude makes my blood boil. By what right does the government presume to decide what’s best for me in the realm of health insurance and then outlaw all the policies I might choose? Only the individual can determine his or her needs when it comes to health care—and if those needs can be met by health insurance, every individual should be free to select and purchase an appropriate policy from among those offered on a free, private market.

Tags: ,

Posted in Government & Policy

Send a comment to the author

Do Canadians have it better? A conversation on the future of American health care [podcast episode #03]

Friday, April 5, 2013 by Rituparna Basu

On this episode of Eye to Eye, I had the opportunity to interview Sally Pipes, a leading proponent for greater freedom in health care. In discussing health care policy issues in this country, people often make comparisons to the health care systems of other nations—the Canadian system is often brought up. I discussed with Ms. Pipes her firsthand experience of socialized medicine in Canada.

One point she made that I found particularly interesting was her discussion of the factors that lead people to have a skewed view of a health care system. When you have routine medical needs (which is the category most people fall in), a health care system fraught with government intrusion may look as if it is working decently. The shortcomings of such a system often only become apparent when you experience out of the ordinary illnesses that require experimentation, innovation and state-of-the-art care. This is important to keep in mind when you hear Canadians saying, as they often do, that their government-run health care system works great.

Another subject we discussed is the frequently cited fact that Canadians spend a lower percentage of their GDP on health care than Americans (11.4% vs. 17.6%). In my view these kinds of collective statistics are dubious and misleading (given the impact of regulatory controls on costs, and the disparate quality of service from one country to another—to name just two problems).

Some of the other topics Ms. Pipes discusses in the podcast include:

  • Why private health care is outlawed in Canada
  • The part of the American health care system that most closely resembles Canada’s
  • Where doctors and patients are going, to escape government intrusion in their medical decisions
  • Why health care in Canada is getting worse

Ms. Pipes is president of the Pacific Research Institute. She writes a column for Forbes.com and is most recently the author of The Pipes Plan: The Top Ten Ways to Dismantle and Replace Obamacare.

Podcast: Play in new window

Tags: , ,

Posted in Government & Policy, Podcast

Send a comment to the author