Topic: Health Care & Welfare

NIDA Director Has Misguided Views on Marijuana Legalization

Today’s Washington Post contains a Ruth Marcus interview of Nora Volkow, head of the National Institute on Drug Abuse.

Volkow opposes marijuana legalization; she believies it will generate a large increase in use, which will (allegedly) harm users and society.

No one knows how much use might increase under legalization; existing evidence suggests a modest change, but since few countries have fully repealed their drug (or alcohol) prohibitions, we do not have decisive evidence.

The fact Volkow ignores, however, is that if use increases substantially, this means many people perceive a significant benefit from increasing their use or from initiating use; that is a positive of legalization, not a negative!

Marijuana use can, of course, generate unwanted side effects, but Volkow exaggerates these enormously. And other goods, like alcohol, also generate negative spillovers; yet we keep them legal (in part) because they generate substantial benefits.

Volkow further ignores the fact that prohibition generates its own negatives, such as violence, corruption, poor quality control, civil liberties infringements, medical restrictions, enforcement costs, and foregone tax revenue (which forces other tax rates to be higher).

So even if legalization means far greater use, and even if this generates undesirable consequences, the sum of benefits for current and prospective users, combined with elimination of prohibition’s costs, makes legalization the right choice.

23andMe Closer to FDA Approval

 23andMe, the Google-backed personal genomics company ordered by the Food and Drug Administration to stop marketing its health-related services in November last year, is closer to a reconciliation with the government agency. The FDA did not object to the ancestry information 23andMe provides, but rather the information on inherited risks it released to customers.

Before halting the release of health information 23andMe had provided its customers with information on their ancestry and health. 23andMe gathered genetic information from customers by having them send saliva in a $99 kit.

What had the FDA concerned was the possibility that a false result from a 23andMe test could lead to customers undergoing drastic procedures such as “prophylactic surgery, chemoprevention, intensive screening, or other morbidity-inducing actions.” Reason magazine’s Ron Bailey pointed out such a fear is misplaced because not only is the biochip used by 23andMe and researchers around the word very accurate, anyone who received worrying health news from a 23andMe test would almost certainly consult a doctor and/or get a more comprehensive screening done before undergoing any surgery or procedure.

Last week 23andMe’s Chief Legal and Regulatory Officer, Kathy Hibbs, wrote on the company’s blog that the FDA had “accepted for review 23andMe’s submission for a new 510 (k) application,” which Reuters describes as “a regulatory process that applies to most medical devices sold in the United States.” The FDA considers the 23andMe saliva collection kit a device.

Although 23andMe’s submission focuses on one condition — Bloom Syndrome — Hibbs wrote the following:

Once cleared, it will help 23andMe, and the FDA, establish the parameters for future submissions. More importantly, for our customers, it marks a baseline on the accuracy and validity of the information we report back to them. The submission includes robust validation data covering major components of our product such as the genotyping chip, software and saliva kit.

While it is good news that 23andMe seems to be on its way to being in good standing with federal regulators, Stephanie M. Lee of SFGate.com notes that 23andMe could potentially face months of questions and data requests before being granted FDA approval.

 

Resources for a Potential Ruling Today in Halbig v. Sebelius

The D.C. Circuit is due to rule any day now, quite possibly today, on Halbig v. Sebelius. For those who haven’t been watching the vigil I keep over at DarwinsFool.comNewsweek calls Halbigthe case that could topple ObamaCare.”

First a little background. The Patient Protection and Affordable Care Act offers refundable “premium-assistance tax credits” to qualified taxpayers who purchase health insurance “through an Exchange established by the State.” The PPACA contains no language authorizing tax credits through the 34 Exchanges established by the federal government in states that declined to establish one themselves, nor does it authorize the Internal Revenue Service to treat those federally established Exchanges as if they had been “established by the State.” Offering benefits only in compliant states was proposed by numerous Republicans and Democrats in 2009, for obvious reasons: Congress cannot force states to implement federal programs, but it can create incentives for states to act, such as by offering health-insurance subsidies to residents of compliant states.

Halbig is one of four cases challenging the IRS’s decision to rewrite the statute and offer tax credits in the 34 states with federal Exchanges. The plaintiffs are individuals and employers who are injured by the IRS’s overreach because, due to the PPACA’s many inter-locking pieces, issuing those illegal tax credits subjects them to illegal penalties.

Since a ruling may come today (or some Tuesday or Friday hence, as is the D.C. Circuit’s habit), here are some materials for those who want to hit the ground running.

Update: The D.C. Circuit has handed down rulings for today, and Halbig is not among them. Click here to check on the court’s most recent rulings.

Congress May Hike VA Spending $400 Billion

Last week the Senate voted to greatly increase health care spending for veterans. If the new spending were made permanent, it would cost at least $385 billion over 10 years, as Nicole Kaeding noted. The House version of the bill would cost at least $477 billion if made permanent. The chambers will now work out a compromise bill, and—going out on a limb here—I’m guessing that the compromise is also a budget buster.

The bills would allow veterans to access health services from facilities outside of the Veterans Affairs (VA) system. The VA system needs a fundamental overhaul, but these bills would appear to just throw money at the problem without creating structural reforms.

The CBO score for the Senate bill is here and for the House bill here. For the House bill, CBO says spending would be $16 billion in 2015 and $28 billion 2016. The House bill would authorize the new spending until 2016, but if Congress extends it permanently the total costs would be $54 billion a year and about $477 billion over 10 years.

I can’t remember an instance when Congress has voted so quickly to spend so much money with so little debate and analysis. The CBO cautioned that their numbers are essentially only rough guesses. So the ultimate spending could be even higher than shown in the chart.

Edwards_VASpendingHouse

Suppressing Competition from Migrant Doctors

The claim for physician licensure is that it protects consumers from “quacks;”  it is just a coincidence that licensure also reduces competition and raises doctors’ incomes!  In this case, the strength of licensing should be similar across states, and licensure requirements should determine whether a prospective doctor is competent, not whether a U.S. native or a migrant.

Recent research by Brenton Peterson, Sonal Pandya, and David Leblang (University of Virginia), however, finds the opposite: 

Licensure regulations ostensibly serve the public interest by certifying competence, but they can simultaneously be formidable barriers to entry by skilled migrants. From a collective action perspective, skilled natives can more easily secure sub-national, occupation-specific policies than influence national immigration policy. We exploit the unique structure of the American medical profession that allows us to distinguish between public interest and protectionist motives for migrant physician licensure regulations. We show that over the 1973–2010 period, states with greater physician control over licensure requirements imposed more stringent requirements for migrant physician licensure and, as a consequence, received fewer new migrant physicians. By our estimates over a third of all US states could reduce their physician shortages by at least 10 percent within 5 years just by equalizing migrant and native licensure requirements.

Little evidence suggests that professonal licensure promotes quality or protects the public, but arbitrary discrimination against migrant physicians (many trained in the United States!) is particularly insane.  As are all restrictions on high-skill (or other) immigration.

Progressivism Is Bad for Your Health

The American citizenry is already used to our progressive friends taxing the hell out of everything they don’t like: smoking, drinking, fatty foods, etc. But now, apparently, the hyper-progressive and very cash-strapped D.C. Council is seriously considering slapping a 5.75 percent tax on health club memberships. That is riveting stuff, considering how many progressives out there are urging the unwashed masses rest of us to eat our broccoli and get on that treadmill.

The nation’s capital is, of course, a temporary home to that most progressive and fittest of couples: POTUS and FLOTUS. There is a government website with a catchy name “Let’s move.” It features many a picture of our First Lady in a variety of physical activities. What fun!

Not to be outdone, the Exerciser in Chief can take pride in “The President’s Challenge,” which is “the premier program of the President’s Council on Fitness, Sports, and Nutrition.” The President’s Challenge, its website tells us, “helps people of all ages and abilities increase their physical activity and improve their fitness through research-based information, easy-to-use tools, and friendly motivation.”

The former British Prime Minister Margaret Thatcher used to say that “the problem with socialism is that eventually you run out of other people’s money.” And so it is with the D.C. council, which in its perpetual quest for more revenue might very well end up discouraging behavior that progressives claim to want to encourage.

Welcome to Absurdistan on the Potomac!

Veterans Need Choice in Choosing Health Care

Medical care for veterans has become Washington’s latest scandal du jour.  Those injured while serving their country deserve prompt, quality medical attention. 

Everyone agrees that forcing veterans to wait, and possibly die waiting, for medical care is outrageous.  But what to do?

Caring for veterans isn’t cheap.  Promiscuous war-making over the last decade has generated an influx of patients, many with debilitating injuries. This year VA is expected to spend roughly $151 billion. 

The government has a solemn duty to care for those injured in war.  Yet VA estimated that it has a case-processing backlog of 344,000.  On average it takes vets 160 days to become eligible for benefits. 

After being declared eligible vets had to wait an average of 115 days for a primary care appointment at the VA’s Phoenix facility.  As many as 40 vets may have died waiting.

The IG found such practices to be “systemic.”  In numerous communities VA employees apparently manipulated data and falsified reports to hide patient deaths as well as delays. 

However, the more basic problem is rationing care to meet budget targets.  The agency is short hundreds of primary care physicians.  The pharmaceutical formulary has roughly one-third of the drugs available to Medicare patients.  Available psychiatric services have declined in recent years.

Unfortunately, better management alone cannot fix the agency’s problems.  In 1994 former Rep. Robert E. Bauman wrote:  “the VA is the quintessential government bureaucracy—administratively officious, laden with red tape and meddlesome regulatory minutia destructive of both quality care and staff conduct.”  Quality obviously suffered. 

The Clinton administration put Kenneth Kizer in charge of the department and he made dramatic improvements.  But his success didn’t last.  After leaving Kizer complained that “The culture of the VA has become rather toxic, intolerant of dissenting view and contradictory opinions.  They have lost their commitment to transparency.”

Even today the VA doesn’t do everything badly.  But access is fundamental. 

Complained Hal Scherz, a doctor who served in VA hospitals in San Antonio and San Diego:  “patients were seen in clinics that were understaffed and overscheduled.  Appointments for X-rays and other tests had to be scheduled months in advance, and longer for surgery.” 

Veterans’ organizations such as Veterans of Foreign Wars traditionally backed a specialized system for vets.  However, many veterans’ health problems are not unusual.  Indeed, the longest waits today are for primary care.  Moreover, there is no reason that only VA facilities can serve patients suffering from combat trauma. 

The federal government should separate the functions of guaranteeing from providing vet access to health care.  As I pointed out in my column on Forbes online:  “Uncle Sam has a sacred obligation to ensure that they receive treatment on their return.  That does not, however, mean the VA must build the hospitals, hire the doctors, and provide the services.”

Government should put money into veterans’ hands to purchase insurance tailored to their special needs.  Existing VA facilities could either be privatized or focused on combat-related ailments common to vets. 

This would be no jump into the unknown.  Specific services are outsourced locally when they are unavailable at a VA facility.  Moreover, only 16 percent of vets rely on the system as their principle caregiver. 

Sen. John McCain, a Vietnam vet, argued:  “Let’s let our veterans choose the health care that they need and want the most and not have to be bound to just going to the VA.”  House Veterans Affairs Chairman Jeff Miller suggested that the VA at least allow vets who have to wait for more than 30 days to go outside for care at government expense.

Business as usual is not an acceptable response to the latest VA scandal.  We should transform how the government cares for those who performed the toughest service of all.