Sink This SCHIP

That’s the catchy title of my oped in today’s New York Post:

The State Children’s Health Insurance Program is set to expire on Sept. 30. Unfortunately, neither side in Washington seems to have considered letting this SCHIP die…

Congress could make coverage more affordable simply by letting consumers and employers purchase out-of-state coverage…

Sweeping away those trade barriers would make coverage more affordable without increasing government spending, trapping families in low-wage jobs or increasing prices for private purchasers.

President of Senegal to Speak at Cato

Since becoming the president of Senegal in 2000, Abdoulaye Wade has been one of Africa’s most vocal proponents of liberal economic reforms. As he recently said, “I don’t want money, and I don’t want hand-outs. I want trade agreements….I believe in a liberal economy and have never put much faith in the state-run economy, because it fails….The state should intervene only to create the conditions necessary for the private sector to thrive. I am counting on the private sector, because it is crucial to Senegal’s future.” Join us on September 28 to hear President Wade discuss economic reforms in Senegal and the future of liberalization on the African continent.

Legal Trends in Bioethics

Starting with the fall issue of The Journal of Clinical Ethics, my “Legal Trends in Bioethics” column will be available on the Cato website at time of publication instead of only several months later. That means the information provided will be more up-to-date and relevant for anyone interested in tracking legal issues in bioethics.

For those not familiar with the column, it tracks bioethics related issue through all stages of litigation, legislation, and regulation at both the federal and state levels, as well as occasionally mentioning exceptional legal developments in other countries. The topics covered are not always exactly the same, but usually there are sections on informed consent, abortion, children’s rights, vaccines, organ procurement, HIV, mental illness, medical privacy, unconventional treatment, right-to-die, stem-cell research and other new technologies, among other topics depending on what bioethics topics are of legal concern in the U.S.

The column tries to be comprehensive as far as reporting the most relevant developments at each level of government and in each topic area. It is a very useful tool for doing exactly what its name implies – tracking the “Legal Trends in Bioethics.” The following is the introduction to the fall column which will be published in The Journal Clinical Ethics and simultaneously become available on the Cato website next month:

The most troubling development in this quarter is the extent to which legislators continue to intervene in the patient/physician relationship by trying to regulate the relationship down to the smallest specifics of what is said and done. These developments are a great threat to both physician and patient autonomy, but while there have been many attempts to pass such invasive legislation, at this point, few of such bills have actually made it into law. It will be important to watch the next two issues of Legal Trends if someone is interested in seeing how many of such bills actually do end up as laws.

The issue of medical tourism is not new to bioethics, but it is on the brink of attracting more attention in U.S. courts and legislatures. There is no separate heading in “Legal Trends” for “medical tourism,” but it is important for anyone interested in the subject to regularly check the “Legal Trends’ subheading dealing with interesting developments in other countries. In this issue, for example, some Canadians are seeking a police investigation into an assisted suicide in Switzerland. Physician assisted suicide is legal in Switzerland, but illegal in Canada. At issue is whether Canadians have a legal right under Canadian law to travel to Switzerland to avail themselves of a practice that is illegal in their own country. In the United States there is a constitutional right to travel which would make it legal for the patient seeking physician assisted suicide to go to Switzerland (there is no case directly on point but the basic principle is well-established in U.S. constitutional jurisprudence), but even in the U.S., as in Canada, it may be possible to prosecute someone who assists that person in getting to Switzerland. This could be considered aiding and abetting a suicide. The Canadian suit has not even been filed yet, and no such case exists in the U.S., but it is an interesting issue to watch. It may come up as it did in Canada with respect to traveling to Switzerland where it is legal for physicians to assist foreigners in committing suicide (this is not true in the Netherlands); it is also likely to come up in connection with people suffering from kidney disease traveling to Iran, the only country where it is legal to purchase kidneys, and in other situations where the legality of the activity is not the issue but the price of medical treatment.

The “Legal Trends” from earlier this year are available on the Cato website or directly from The Journal of Clinical Ethics.

Cash-Only House Calls

An article in today’s New York Times provides another example of how, when the patient owns and controls the money involved, entrepreneurs respond with medical services far more convenient and customer-friendly than your typical doctor’s office visit. 

Critics of physician house-call services will argue that such services are great if you have $250 to $450 to spare.  I see these stories and wonder what types of services low-income workers would already have if they had been allowed to own and control all of their health care dollars for the past several decades.

H.T. Bob Budd.

Washington Post’s Popular Programs

Washington Post, September 18: “The Democratic Congress is considering 2008 spending bills that increase funding for politically popular programs….”

Washington Post, September 19: “With a difficult war debate looming and presidential vetoes for a host of popular legislation….”

Washington Post, September 20: “Republicans and Democrats in the [Virginia] General Assembly proposed election-year spending increases for popular programs….”

Notice any pattern? 

The Washington Post is a great paper, but like many papers it reveals a pro-spending bias when it reports on government budget issues. One aspect of this is the common portrayal of any increase or cut as affecting “popular programs.” Every type of program is portrayed as “popular,” whether it provides benefits to 50% of Americans or just 0.05% of Americans.

Presumably, Post reporters don’t do a public poll to find out which programs really are ”popular.” Instead, they just automatically stick the word in stories to perhaps suggest, “Ohhh, policymakers better not cut spending on that one or else there will be hell to pay.”

I’ve noticed this for years in the PostHere’s one on federal grants to local governments: “According to the police group, the most controversial proposals include a $376 million reduction in the popular Community Oriented Policing Services program….”

Washington Post readers sometimes complain that its stories are too wordy. Well, “popular” is one word that editors can look to chop out.  

Pelosi’s World

House Speaker Nancy Pelosi’s understanding of government’s role in a liberal democracy (and of the veto power) may be worse than I thought. A reporter sends a transcript of a press conference that Pelosi held yesterday, where she made the following remarks:

Oh, [President Bush] used the veto pen to veto the stem cell research bill.  That was a major disappointment… . I remember that veto very well because he was saying, “I forbid science to proceed to improve the health of the American people.”

Regarding Bush’s threatened veto of the Democrats’ expansion of the State Children’s Health Insurance Program:

The President is saying, “I forbid 10 million children in America to have health care.” You know from your Latin that is what “veto” means.

Pelosi should know that there is a difference between the government not funding something and forbidding it. 

My colleague Sigrid-Fry Revere documents that stem-cell research proceeds even — or especially? — in the absence of government funding. Anyone with passing familiarity with SCHIP knows the program covers millions of children who would have health insurance anyway — and even more children who would still get health care if the program disappeared tomorrow. Yet Pelosi thinks that vetoing SCHIP expansion is the equivalent of stormtroopers kicking in clinic doors to stop a well-baby visit.

Notably, no one from the press challenged either comment.