208 Farce

 Posted by on 22 May 2007 at 8:02 pm  Health Care
May 222007

Colorado’s 208 Commission for Health Care Reform has chosen its four proposals to evaluate. Basically, after a pro-government-medicine biased analysis by some consulting firm, the Commission will recommend one plan to the Colorado legislature. As expected, the selected plans range from awful to disastrous. Lin Zinser has posted a helpful analysis of them to the FIRM blog.

On Sunday, I dashed off the following letter to the commissioners:

Dear 208 Commissioners,

I wish to express my profound disappointment with the Commission’s choice of healthcare reform proposals to evaluate. All four proposals are basically the same: all would significantly increase the already-overwhelming burden of government regulations, mandates, and entitlements in medicine. If implemented, the results would be exactly the same as in other countries and states, i.e. runaway costs, rationing of services, and declining quality. The only difference between these four proposals is the speed with which each would destroy the high quality of medical care now available in Colorado.

You could have chosen to give a serious hearing to something genuinely different, namely the free-market approach of Brian Schwartz’s “FAIR” proposal. Instead, you’ve decided that only plans that inject tons more government force into medicine will be considered.

What a farce.

Diana Hsieh
Sedalia, CO

Obviously, I cannot hope to change the decision of the Commission at this point, but clear and strong opposition can convey the message that their “idealistic” plans for reform would be serious political risk.

Letters to the 208 Commission

 Posted by on 12 May 2007 at 12:29 pm  Health Care
May 122007

Today is the last day for public comment to Colorado’s “208 Commission on Health Care Reform.” If you’re already written, thank you! If you live in Colorado but haven’t yet written, please please please do so. You can make a difference! Even just a quick paragraph advocating free market reforms would be fantastic. If you have more than a spare moment to craft a letter, you should look at Lin Zinser’s We Stand FIRM blog post about writing the commission. Below, I’ve included the letters from Lin Zinser, Paul Hsieh, and myself.

From Lin Zinser:

Americans can freely choose where to live and what kind of housing we can afford. We can choose whether to buy a car and, if so, what kind, size and price we want to spend. We can choose what kind of food to eat and whether we want it ready-made, as in restaurants or fast food joints, or whether we want it partially made, or from fresh ingredients — where we do the preparation. We can choose what kinds of entertainment we seek, including movies, CDs, books, or whether to attend live events like wrestling matches, theater, concerts or the opera. We can choose what kind of work we do, our place of employment, and some can choose what hours to work, and whether to work from home, an office or outdoors. These are among thousands of other choices Americans make in our lives — and because we live in America we have more choices than most other people in the rest of the world.

We can choose to live simply, without electricity — as a friend’s 93 year old grandmother chooses to do because she thinks simple is better, or with as much technology and space as Bill Gates can buy. We can choose to buy clothes at second hand shops — as many of my financially well-off girl-friends do, or we can choose to spend hundreds of dollars on a haircut as Presidential Candidate John Edwards does. We can shop for groceries at Walmart, 24 hours a day, or at Whole Foods, where we pay more for organic foods. Our economic choices are not forced on us by our political status or our government.

These are the kinds of choices that people from around the world come to America to experience — for a lifetime. People from around the world also come to America to get the latest medical technology, the newest life-saving drug, and some of the most radical treatments available, even if incompletely tested or proven — in order to save their lives.

Think about one astonishing fact — the people in countries with universal, mandatory health coverage — including the Europe, Great Britain and Canada — even if taken together, have not created the wonderful, magnificent changes that we have seen over the past 40 years in medicine in America even though their population is more than 3 times the American population. In most of these countries, such wonderful life saving treatments, even if adopted from America, are restricted or rationed.

Why has America led all of these countries in medical advancements that have enhanced the quality of life of all, including premature infants, people with failing organs, cancer victims and aging Americans? Why is there no rationing in America? Why do people come to this country for advanced treatment s for cancer and other diseases? The answer is Capitalism — the social, economic and political system which allows men and women to use their minds in freedom, thus providing creators and producers the financial incentive — the profit motive — to investigate new (hence unproved and untried) technologies and new science, even at the risk of failure.

Government controlled health insurance and medicine do not foster change and innovation. They foster the status quo. One reason is that any government program, looking at unproved and untried methods or strategies, cannot spend taxpayer dollars on them for political reasons — the risk is too great. Additionally, Government tends to enforce one standard of doing things — one way of treatment — whether it’s the post office or health care. It took Fed Ex and UPS to provide choice in how fast a package could be delivered. There is one Medicare part A for all Americans 65 or older. Medicaid participants don’t have choices — they have limited options. But, how many choices do Americans make with regard to food, clothing, housing, transportation and entertainment every day of our lives.

The only reasonable principle for health insurance and medicine is the principle uniquely forged by the founding fathers. It is the principle enshrined by the Declaration of Independence and the US Constitution — that all are created equal with the inalienable rights to life, liberty and the pursuit of happiness. Those inalienable rights require a social-economic-political system that promotes freedom of action — the freedom that allows Americans to make all of the choices I mentioned — and more. In Colorado, we need American health insurance and American medicine with its innovation and enhancement of the quality of life — not another European government program of the status quo.

Lin Zinser
Executive Director
Ideas Matter!, Inc.

From Paul Hsieh:

Dear 208 Commission:

Here are my responses to the two questions on which you have requested public input, regarding the health care proposals under consideration:

“(1) What are the one or two most important features that you feel must be included in any Colorado health care reform?”

The most important feature would be reduction or elimination of mandates on individuals, insurance companies, and employers. This will allow patients, doctors, and payers to negotiate the best agreements for themselves without being constrained by government force. Mandates on employers and insurance companies (such as mandatory benefit packages, guaranteed issue and/or community ratings) drive up costs without providing better care. Mandates on individuals violate the freedom of contract between patients and their doctors and force one set of patients to subsidize the health care of another set of patients. Individuals can and should be allowed to decide for themselves how to most wisely spend their health care dollars.

“(2) What is the most important principle that should be considered in any reform effort?”

The most important principle is that only free market capitalism can guarantee good quality health care at the lowest prices for patients. Countries and US states in which allocation of health care resources are left to the government inevitably spend more money for poorer-quality care. Plus the decision making become irreversibly politicized, which harms patients who don’t have powerful political friends. The free market is the only way to protect the individual rights of patients and doctors. Hence, we must avoid more government mandates, or mandates disguised as limited “choices” within a set of government-selected options.

Patients, providers, and payers working within a free market will come up with innovative and cost-effective solutions that would never occur to central government planners. To deprive patients of that opportunity violates their basic rights and will cause them harm.

Reference: The Cure: How Capitalism Can Save American Health Care, book by Dr. David Gratzer, a physician who has practiced in both the US and Canada. Among other points, he shows how the government-run medical system results in higher mortality rates for treatable conditions in countries like Canada vs. the USA. Any government-run system of health care will result in more deaths of Colorado patients from to treatable diseases such as breast cancer, prostate cancer, heart disease, stroke, etc.

Thank you very much,
Paul Hsieh, MD
Sedalia, CO
[email protected]

From Diana Hsieh:

Dear 208 Commissioners,

I am writing to encourage you to uphold free market principles in your deliberations about health care reform proposals. A free market in health care — as opposed to the current system of massive regulations, mandates, and entitlements — is the only moral and practical option. All the problems from which medicine currently suffers (such as high prices for medical care, non-portable insurance, and the over-use of emergency rooms) stem from government interference in the free market.

Only free markets permit doctors, nurses, and other medical providers to act for the best interests of their patients. Only free markets allow patients to choose how to best spend their hard-earned money to secure and promote their own health. Any other system — meaning any system with regulations, mandates, and entitlements — injects bureaucrats into what ought to be wholly private decisions. Patients are told that they must wait months for critical care — or they are simply denied care altogether. That kind of government meddling is inevitable. When government pays for medical care, neither doctors nor patients have any incentive to use the available medical services judiciously. Then, to prevent total financial ruin from runaway costs (and fraud), the government must step in to limit the use of medical services, whether by rationing care or denying care. Unless the system is scrapped, people will suffer and people will die. That’s what the supposedly noble ideal of “universal coverage” means in practice.

The 208 Commission has a wonderful opportunity to help repeal the mandates, regulations, and entitlements that currently burden medical care for the doctors and patients of Colorado. If you do that, you can make Colorado a genuine leader in health care reform!


Diana Hsieh
Sedalia, CO

Please feel free to post your letter to the 208 Commission in the comments.

208 Commission

 Posted by on 8 May 2007 at 8:06 pm  Health Care
May 082007

Lin Zinser just posted this entry about Colorado’s 208 Commission on healthcare reform to the FIRM blog. I think it’s important enough to repeat here on NoodleFood.

Between now and Saturday, May 12, 2007, is the only real opportunity to voice your concerns to the 208 Commission through the public comment. After May 12, there is no opportunity for public comment before they select the 3 to 5 proposals, which they will do at public hearings on May 17 and May 18. These 3 to 5 proposals will be the ones submitted to the state legislature next January for its consideration. This means that you and your voice could be heard by the legislature through the commission.

There are currently 11 proposals being considered. I have summarized the 11 proposals briefly below — at the end of this post.

Only one of the proposals recommends deregulation of the insurance market and of Medicaid. That proposal was submitted by Brian Schwartz, PhD, and his full proposal (worth reading) is called FAIR (Free Markets, Affordability and Individual Rights). (You must download it – it’s toward the bottom of the page).

The Commission numbered each tendered proposal — and the FAIR plan is number 21. The other plans include individual mandates, insurance company benefit mandates, insurance company guaranteed issue and community rating mandates, employer mandates, provider mandates, or some combination of the above. My summary of all eleven is provided at the end of this post.

The Commission is requesting comment on 2 issues related to these proposals:

1) What are the one or two most important features that you feel must be included in any Colorado health care reform?
2) What is the most important principle that should be considered in any reform effort?

There are two ways to provide comment to the 208 Commission. 1) You may submit a comment in writing by e-mail to [email protected] It is crucial to send your comments this way. Any comment sent to this address will be posted on the Commission website and distributed to all Commissioners for review in advance of the May 17-18 meeting. But the e-mail must be received by May 12. Comments sent to individual commissioners, or received after the deadline will be ignored.

Alternatively, there are five meetings planned across the state this week — May 10 and May 12 — for public comment and where you have the opportunity to speak before one or more commissioners. They still want you to submit written testimony at the time of your oral presentation.

This is the last opportunity to express your opinion about the most important principle (and features) to be used to select any proposal. This is the time to speak about capitalism v. government control, the individual rights of doctors and other providers v. the needs of some patients, and freedom in medicine and health insurance v. insurance mandates and other instances of government force.

To be effective to the Commission, any written (or oral) comments must state specifically ONLY the principle and or features that are most important to health care reform, and to give specific reasons for that choice. They are not interested in your advocacy or rejection of any particular proposal.

Some examples of written comments to the 208 Commission might be

  • The most important feature to include in any health care reform would be to eliminate all mandates — whether they require individuals or employers to purchase health insurance, or whether they impose benefit packages on insurance companies, or impose mandatory guaranteed issue and/or community ratings of insurance companies; or any mandate on the care or treatment (including the cost for that care) provided by any health care provider. Mandates violate the freedom of contract between individuals, doctors and insurers. They also increase the cost of health insurance policies for the healthier citizens by subsidizing the cost of those who are not as healthy. OR,
  • The most important principle to consider in any health care reform would be that only capitalism can provide the best quality of medicine and health insurance at the lowest possible price. For example, the United States leads the world in innovative, new science and technology in medicine because of its tendency towards market based solutions, not in spite of them. Government controlled medicine and insurance advocate the status quo, and are resistant to change. To continue to have better and better technology to save more premature births, to enhance the quality of the lives of diabetics, heart patients, cancer victims old age survivors, as well as countless other conditions, we must turn to capitalism and capitalism alone, for its infinite choices and solutions, made by individuals in a free market. OR,
  • The most important principle to consider is that government involvement in medicine has caused the problems we face in health care today and we need to get government out of medicine. For example, the 1942 IRS ruling distorted the market to favor employer-purchased health insurance policies over individual purchased ones, thus taking the responsibility for the purchase of health insurance from the individual, eliminating portability, transparency of the costs of medical services and health insurance, and encouraging too much coverage for routine care, while discouraging catastrophic care coverage. Another example is EMT ALA, which required all hospitals with emergency rooms (and their doctors) to treat any person, regardless of ability to pay, who believed they had an emergent health issue. This caused doctors and hospitals to treat some people, while getting paid nothing. This in turn caused hospitals and doctors to charge others who could pay more, and caused some hospitals and doctors to stop providing care — to close emergency rooms and to stop practicing at hospitals with emergency rooms. We need to eliminate provider mandates. OR,
  • The most important principle of any health care reform would be respecting individual rights of doctors, insurers, employers and individuals. Doctors and hospitals must be free of mandates that require them to participate in any program (e.g., EMT ALA). Insurers must be free to contract and provide whatever benefits they deem profitable or appropriate (eliminate all mandates including mandatory guaranteed issue and community rating). Employers and individuals must be free to purchase health insurance at whatever level they deem appropriate (e.g., high deductible – HSA, basic minimum, catastrophic only, etc.). No one has a right to force others to provide him or her health care or health insurance — even though many governments have treated both as temporary privileges — granting benefits which it can then take away depending on cost, majority vote, or other illusory standard

Again, these are examples. The crucial thing is to pick the most important principle for health care reform, or one or two features that are important to consider in health care reform, and make them your own. Feel free to use any of these, expanding or narrowing them to suit your situation. There are many more specific examples for any principle or feature that could be used.

NOW IS THE TIME to send your comments to the 208 Commission. The Commissioners need to understand what is important to you, what principles are crucial to you and how those principles are manifested in features of the various proposals.

To assist you in understanding the essential features of all eleven plans being considered for submission to the legislature, I have summarized them below. You may read the full proposals at the 208 Commmission website by downloading any or all from this page. I used the commission number for each plan. These 11 proposals are as follows:

#21 – FAIR (Free Markets, Affordability and Individual Rights) proposed by Brian Schwartz, PHD. Plan proposes to lower cost of health insurance by eliminating all insurance benefit mandates, thus allowing people to obtain less coverage for fewer dollars. Eliminates single-group of one which eliminate guaranteed issue and community rating for that market.
Seeks to encourage high deductible HSA health insurance plans.

Medicaid Reform seeks to transfer more enrollees into private insurance market. It also uses cost-sharing to eliminate over-consumption of some Medicaid services. He also advocates reduction of asset sheltering for long term care in Medicaid. He also advocates increasing access to home care and, most provocatively, to allow Medicaid to compete for funding with voluntary charities in the private market.

#16 — The Colorado Health Services Program, proposed by Health Care for All Colorado Coalition – is a single payer, publicly financed program. It covers all primary, preventive, specialty, surgical care, automobile and work-related injuries, prescription drugs, mental health services, chiropractic, dental, basic vision, audiology, home health and hospice services, among others. It states that all providers and hospitals will be paid the same for the same level of service, thus eliminating the drive for profit in determining the quality of care. It is explicitly egalitarian and states that every resident has equal access to program benefits. There is no opt-out provision.

It calls for a statewide, fully integrated information technology network to track outcomes, utilization and expenditures. Removes profit motive from financing resulting in a truly egalitarian health care system. Would create the Colorado Health Services: a non-profit government “insurance company,” administered and governed as a public utility with five districts and it would be strictly regulatory – no outside supervision or control. All of its decisions final. It would also determine malpractice, but allow its findings to be public in malpractice litigation in a court of law.

#12 – A Plan for Covering Colorado, proposed by the Committee for Colorado Health Care Solutions – requires a single insurance pool – in which all insurers would be required to participate and would be mandatory guaranteed issue and community rated. All individuals, including all state employees, and employers will be mandated to purchase insurance through the single pool. Employers would be mandated to pay a portion of the employees’ health insurance or pay an assessment to the state per employee. Individuals (and employers) would be limited to opt for one of 6 to 10 standardized benefit plans. Policy mandates would include a list of essential services, but could include options of type (PPO or HMO), choice of provider panels, and amounts of co-pays or deductibles allowed. Employers required to allow workers to pay their share of premium through payroll deduction. So employers become the enforcement mechanism — they collect the premium and forward to the state.

This single insurance pool wold be administered by new public authority – Colorado Health Insurance Purchasing Authority. It will define benefit packages, define and periodically update a standard set of benefits based on effectiveness and cost, define and certify “high-value” providers, define subsidy and premium assistance requirements to be provided to low to middle income individuals. Consumers with premium assistance can opt for only 2 plans, with one an HMO. Authority will also decide guidelines for performance of providers, and of course, determine the amounts paid to the providers.

#11 – Community of Caring proposed by a coalition of CCHN, CCC, CA and CBHC. Individuals have mandate to purchase adequate health insurance; there is also an employer mandate to contribute to employee coverage; Insurers must guarantee insurance regardless of health according to community rating. The plan will provide subsidies to low-income and small businesses and expand Medicaid to more people. Benefits will include preventive care, routine medical services, maternity, diagnostic testing, hospitalization, emergency care, outpatient surgery, mental health and substance abuse treatment, physical, occupational and speech therapies; in-home, hospice, and nursing facility care; durable medical equipment and pharmacy, plus oral health benefits.

Creates a quasi-governmental entity that is exempt from TABOR called Health Insurance Partnership. Also creates and funds the Community of Caring Collaborative Board and the Safety Net Stabilization Program. It will establish comprehensive benefits package, competitively negotiate contracts with private health plans; implement quality standards for insurers and providers; and collect taxes from individuals and employers for the program, and collect monies from state agencies and premiums from health insurers for more funding. It says it will provide a variety of products that modify cost sharing or offer enhanced benefits.

#10 – Healthy Colorado Now – proposed by the Colorado Coalition for the Medically Underserved. Employer Mandated on pay or play basis, which means that employers must pay for insurance or pay an assessment per employee to the state. Policies are guaranteed issue, community rated, standard benefits. There will be a default enrollment system with individual mandates, but the employer is ultimately responsible if the individual doesn’t purchase insurance. Benefits will exclude services without proven benefits or with poor cost benefit ratios, so no experimentation or new technologies can be tested or tried. There will be spending caps per individual beneficiary. There will also be a limitation of expensive and heroic services.

Creates the Personal Responsibility Option in Colorado (PRO-CO). Governed by non-profit, non-governmental authority called the Colorado Health Authority. Adopt “medical home” standards, which mandates that every individual must choose a primary care physican who then becomes a gate keeper for specialty services. The plan supposedly creates incentives for standardized care. It will implement new information technology, define standard policy benefits, and provide quality and performance standards. Every non-ERISA insurer must offer at least the PRO-CO benefit package. Individuals do have the option to buy higher levels of coverage. Evidence based medicine.

#9 – An Individual Based Insurance System proposed by the South Denver Metro Chamber of Commerce. Individual and Insurance Company mandates. Mandatory maintenance routine care policies (up to $100,000) and mandatory preventive care (required to get annual exam). Guaranteed issue, community rating. Catastrophic care funded by 5 to 20% of maintenance policy premiums – with financial backing of the pool from a state governmental safety net similar to the role of the FDIC. Mandated benefits on maintenance policies – may limit benefits on cosmetic, self-inflicted, treatment without a reasonable scientific basis, highly experimental, infertility and repetitive injuries caused by extreme choices.

Creates Colorado Health Commission to investigate quality and cost factors that “drive” cost and quality. Discounts for health lifestyle choices. Massachusetts style connector to link insurers and consumers. Vouchers for poor. State clinics for poor and uninsured – one per county.

#7 – Connecting Care and Health for Colorado proposed by CCHI. Universal coverage. Individual and employer mandates. Guaranteed Issue and Community rating. Expansion of public programs. Standardized benefits, including minimum benefit requirement. Diagnosis and treatment, preventive dental care, vision and hearing services, mental health, substance abuse, cancer screenings and other chronic disease screenings, rehab services, non-emergent medical transportation and other appropriate services.

Creates the Stakeholder Oversight Commission to supervise 3 advisory committees – health care quality, rural health and health disparities. Private insurance includes all state mandated benefits and two or three enhanced plans that include vision and dental benefits. Tax assessment on employers with tax credit for those who provide health insurance. Mandate all residents to purchase insurance.

#6 – A Phased Approach to Achieving Universal Health Coverage in Colorado proposed by Kaiser Permanente.
Expand Medicaid programs to children with premium assistance. Individual mandates such that an individual must have coverage through their employer, individually private coverage or through a public program. There will be a tax and surcharge on those who remain uninsured. Guaranteed issue, community rating. Would increase and encourage the use of HMOs. A medical home or primary physician essential. Evidence based guidelines. Statewide medical records database.

Uses voluntary HMOs and providers; but also a statewide managed indemnity plan mandated for those not in HMO. Individuals in indemnity plan must choose primary care physician – a medical home. Reimbursement rate is 100% of medicare for non-HMO providers, HMO rates are reimbursed on a capitated basis and determined at the state level. Individuals eligible for group plan must use that plan. Basic or comprehensive plan with a deductible (0, $2000 or $10,000).

#4 – Comprehensive Health Care Plan for Colorado proposed by CLUB 20. Individual mandates for tier 1 coverage – basic benefits using appropriate associated reimbursement rates using Oregon as model. Providers mandated to participate in quality improvement efforts and meet quality standards.

It would create Colorado Health Commission to coordinate and direct new overarching elements of health care reform. Also would create the Colorado Care Connector to assume role of current medical and efficiently provide Tier 1 coverage to those who can’t afford it. Promote concept of medical home with primary care provider. Can purchase Tier 2 coverage – which allows for unlimited health care options.

#2 – Better Health Care for Colorado proposed by Service Employees International Union. This plan is a bit vague but seeks to create a path for universal health coverage. It doesn’t appear to have mandates, but I’m not sure how universal coverage is to be enforced without mandates.

It would create a new quasi-public entity to provide access to private insurance specifically tailored for “target” populations. The exchange would coordinate health care financing from multiple sources, and offer products to subsidized uninsured and non-subsidized small businesses. Would offer limited health plan of $25,000 to $35,000 annual benefit; pre-paid plan; more comprehensive coverage such as in the State Employee Health Insurance Plan, and other plans for indigent or high risks. Managed care approach. Would have employer-sponsored insurance with an opt-out provision.

Update on "Infuriated Socialists"

 Posted by on 1 May 2007 at 11:37 am  Health Care
May 012007

The Denver Post did publish my response to the Jim Spencer column in today’s edition:

Jim Spencer called my April 25 letter “crazy” and accused me of violating my oath as a physician because I argued that health care is not a right.

The exact opposite is true. My moral responsibility to my patients requires that I oppose socialized medicine. When countries like Canada attempt to guarantee a “right” to health care, it inevitably leads to rationing of vital medical services. Under their “single payer” system, Canadian patients routinely wait for months before government bureaucrats allow them to get MRI scans or surgeries that are immediately available in the U.S. Doctors cannot practice good medicine when handcuffed by such a system – and many will quit medicine rather than work under those conditions. (For more information, see www.WeStandFIRM.org.)

Trying to create a universal “right” to health care turns patients into pieces of meat and turns doctors into slaves. Neither is right for Colorado.

Paul Hsieh, M.D., Sedalia

The other letter they published at the same time was also good:

Jim Spencer refers to a letter from a physician regarding the “right” to health care as the craziest he has read in some time. Plainly, Mr. Spencer has no idea what a “right” is.

A “right” refers to a freedom of action that an individual possesses. For example, “the pursuit of happiness.” It does not refer to a sanctioned or legalized gain of unearned goods or services, nor does it involve the violation of others’ rights. These are more properly termed “theft” or “slavery,” and are obviously immoral.

A “right” to health care necessarily involves enslavement of health care workers (Canadian physicians have no right to private contracts) and confiscation and redistribution of tax monies.

If it were so easy to provide health care as a “right” by simple legislative fiat, as Mr. Spencer implies, then I cannot understand why we do not end hunger by passing a similar law forcing restaurants to provide food.

The health care problems we have now would best be addressed by reintroduction of the concept of personal responsibility, re-establishment of a free market and the rewarding of charity care. Only then will “rights” truly be respected.

(They left his name off the online version, but the print version lists him as “Michael K. Stahl, M.D., Carbondale”.)

After reading the Spencer column and my reply, one of my partners also e-mailed me:

Amazing. Absolutely amazing. While reading Spencer’s article, the “looters” from Atlas Shrugged kept coming to mind. Keep fighting the good fight.

I had no idea that he had any familiarity with either Atlas Shrugged or Ayn Rand, so that was a pleasant surprise!

Apr 302007

The state of Maine has also attempted to provide “universal coverage” for its residents for many years, with predictably poor results. According to this recent NY Times article, instead of saving money, the program costs continue to explode, and the state officials are considering what sort of cutbacks to implement. Rationing is just one short step away.

Interestingly enough, one of the supporters of the plan is quite explicit about the central problem. She states, “This program needs healthy people who don’t get subsidized so it can prosper.” In other words, it needs a massive forced redistribution of wealth from one group of citizens to pay for the health care of another group of citizens who otherwise couldn’t pay for it themselves.

Yet for some reason, supporters of “universal health care” refuse to call these systems by their real name — “socialized medicine”! (Via Jason Spears.)

(Also crossposted to the FIRM weblog.)

Infuriated Socialists

 Posted by on 27 April 2007 at 9:13 am  Health Care
Apr 272007

A few days ago, Paul published this letter to the editor in the Denver Post:

Health care is not a right, and it is not the proper role of government to provide health care for all citizens. Instead, this should be left to the free market. It is precisely the attempts of the governments of countries like Canada (or states like Tennessee) to attempt to mandate universal coverage which have led to the rationing and waiting lists for vital medical services. Similar problems are already starting to develop in the Massachusetts plan as well. Any plan of government-mandated “universal coverage” is nothing more than socialized medicine, and would be a disaster for Colorado.

Paul S. Hsieh, M.D., Sedalia

In response, Denver Post staff columnist Jim Spencer attacked Paul (without identifying him by name) in his column “Reforming the health of our care“:

The craziest letter to the editor that I’ve read in some time came from a physician who claimed that Coloradans have no right to health care.

Seems the guy not only forgot his Hippocratic oath but also the law.

If you’re sick enough or badly injured, they have to treat you at the emergency room regardless of your ability to pay.

The doctor aimed his editorial rant against socialized medicine. But he wrote it because a state blue-ribbon commission is now cobbling together a plan for medical treatment and prescription drugs for Coloradans.

The column then discusses the supposedly noble work of the 208 Commission in determining the proper “private/public mix in the provision of health care.”

I’m tickled pink to see Paul causing such a stir. It shows the power that physicians have when they speak out against socialized medicine.

For more information about the fight against socialized medicine in Colorado, visit FIRM: Freedom and Individual Rights in Medicine. For Paul’s more detailed case against socialized medicine in Colorado, read Socialized Medicine in Colorado – An Open Letter to Colorado Physicians.

Daily Health Check

 Posted by on 13 April 2007 at 6:48 am  Health Care
Apr 132007

This NY Times article “Lessons of Heart Disease, Learned and Ignored” has some really valuable information on the common confusions about heart attacks that lull people into complacency, such that they don’t avail themselves of the proper treatment options. It’s well-worth reading, particularly if you have family history of heart disease, as I do.

A few days ago, Paul told me of a woman who failed to check out chronic belly pain for months until it became unbearable. At that point, the CT and MRI scans showed colon cancer, already spread to the liver. That’s not good: a friend of ours died about 18 months after a similar diagnosis. (She suffered no symptoms until she fainted on the subway.)

On hearing the story, I suddenly struck by an indirect health benefit of my daily course of vigorous exercise: I would never endure such pain for more than a few days (if that) — not just due to general worry about the cause of the pain but also due to very specific annoyance with my inability to exercise as usual. The same is true of the fatigue that often comes with heart attack mentioned in article above: the problem surely wouldn’t be quite so clear or so pressing to me if I were a couch potato.

In other words, exercise doesn’t promote health merely by making the body more fit; it’s also an important daily test of one’s health. That’s kinda cool, I think.

P.S. Happy Friday the 13th! It’s my lucky day… I was born on Friday, December 13th, 1974.


Socialized Medicine in Colorado — An Open Letter to Colorado Physicians
by Paul S. Hsieh, MD; [email protected]

Dear Colleagues:

My name is Dr. Paul Hsieh, and I am a physician practicing in the south Denver metro area.

I am deeply concerned that socialized medicine may be imposed on Colorado by our state legislature within the next year or so under the guise of “comprehensive health care reform”. I’m morally opposed to this because I believe it would be destructive to our medical practices and harmful to our patients. I’d like your help now in speaking out against this ominous prospect.

The political process which could lead to socialized medicine is already underway, but most working physicians I’ve spoken with have been unaware of it. Hence, I want to sound the alarm before it’s too late.

As some of you may know, in June 2006 the Colorado state legislature authorized a special 24-person Commission (called the “208 Commission” after Senate bill SB208) to generate proposals to restructure the health care system in Colorado, and submit them for legislative approval. The Commissioners were chosen by politicians from both political parties. Currently, there are only two doctors on the 208 Commission; the other 22 are representatives of various special interest groups.

The basic premise of the 208 Commission is that the government must guarantee health care for all Coloradoans. During their public meetings, a significant number of the Commissioners have expressed support for some form of socialized medicine. Although they frequently use euphemisms such as “single payer” or “universal mandatory coverage”, similar language has been used in other US states and in other countries to justify massive government control of medicine.

Simultaneously, the Colorado Medical Society (CMS) has developed an official position in which they urged that health care in Colorado should be “universal, continuous, portable, and mandatory“.

On January 25, 2007, the CMS submitted those “Guiding Principles” to the 208 Commission, portraying them as the consensus of the doctors of Colorado. They have also stated that the “CMS believes, after extensive vetting and a unanimous vote at the 2006 House of Delegates, that the Guiding Principles represent a compelling consensus of Colorado physicians”.

When I first learned of this, I was angered and appalled, because that position does not reflect my views or the views of many other physicians that I’ve spoken with. The CMS does not speak for me on this issue, and I am not part of this “compelling consensus”.

I completely oppose any form of socialized medicine, regardless of whether it is called “single payer”, “mandatory universal coverage”, or anything else, because I believe it would be bad for both patients and doctors. Years of experience in the US and other countries have shown that these programs will hurt patients and even cause their deaths. As costs inevitably spiral upward, bureaucrats will ration medical services. Eventually, physicians will be forced to practice against their best medical judgment. This is a violation of the fundamental rights of both doctors and patients.

As a result, in states like Tennessee (which in 1994 implemented its own version of mandatory universal coverage called TennCare), many doctors find the practice climate intolerable and are either leaving the state or quitting medicine entirely. I do not want that to happen in Colorado. States like Massachusetts and California, which are also attempting to guarantee universal health care for their residents, will soon face similar problems.

Although I agree that there are genuine problems with the current system, more government interference in medicine can only make things worse. One basic principle we all learned in medical school was, “First, do no harm”. This applies as well to politics as it does to clinical practice. Most of the problems of the current system have been the result of bad government policies. Adding more government bureaucrats to the mix will only make things worse.

In my opinion, it is not the government’s role to guarantee health care for all Coloradoans, any more than it is the government’s job to guarantee all citizens a car or a job. It is morally wrong and economically unsustainable. Doctors and patients ought to be able to freely contract for medical services to their mutual benefit without interference from the government. It is precisely the attempts by the governments in Canada and Great Britain (or states like Tennessee) to guarantee universal “cradle-to-grave” coverage that has led to the runaway costs and rapidly deteriorating health care in those places.

I recognize that not everyone will agree with me here, and this is part of my point. This is a very contentious issue amongst doctors. Based on my discussions with numerous physicians, I don’t think one can accurately say that there is a “compelling consensus” of the doctors of Colorado.

So if you oppose socialized medicine on the grounds of medical conscience (as I do), then please contact the Colorado Medical Society and the 208 Commission, and let them know where you stand.

Even a one line e-mail like, “I oppose universal, mandatory coverage or any other form of socialized medicine, because it will be bad for me and my patients”, could have a tremendous impact.

To contact the relevant members of the CMS and the 208 Commission go to: http://tinyurl.com/2y9t4f or send mail to [email protected].

The CMS is speaking in your name on this issue, so if you disagree with their position (or if you believe that their position should not be portrayed as the physician “consensus”), then they need to know. The CMS has requested feedback from doctors including those who disagree with their current position, so I urge you to take them up on this.

The 208 Commission is a public body, and has also asked for input from all citizens of Colorado. So if you want to protect your right to practice good medicine and protect your patients’ best interests, they need to hear from you before they submit their proposals to the state legislature for a vote.

For further information about this issue, one excellent resource is the website www.WeStandFIRM.org, a non-profit group of Coloradoans devoted to freedom and individual rights in medicine. I especially recommend their article, “Health Care is Not a Right” by Dr. Leonard Peikoff. If you wish to stay informed on this topic, I also encourage you to sign up for their mailing list or read their blog.

Also, please feel free to forward this open letter to any other Colorado physicians that may be interested. A copy of this letter is also available online at: http://www.WeStandFIRM.org/docs/Hsieh-01.html.

Paul S. Hsieh, MD
E-mail: [email protected]

Disclaimer: I am neither a Republican nor a Democrat, but an independent voter. My objections to socialized medicine are unrelated to party politics.



I’ve listed some references for those who want more information. These are optional resources for those who want to learn more about these topics, but not required reading. (I do not necessarily endorse every item in full):

Health Care is Not a Right” (HTML format or PDF format):
[Online essay] This brilliant essay was written by Dr. Leonard Peikoff, a philosophy PhD living in Colorado Springs. The original version was written in the 1990′s after Hillary Clinton proposed her infamous national health care plan, and has been updated by Lin Zinser and Dr. Peikoff for 2007. He argues that a “right” to health care does not exist and that any attempt to create one necessarily leads to disaster, because it runs antithetical to the genuine rights that were recognized and codified in the Constitution by the American Founding Fathers.

A Short Course in Brain Surgery“:
[Video] This astounding 5-minute video tells the story of an Ontario man with a brain tumor who couldn’t get the care he needed under the Canadian system because the waiting lists for an MRI scan and for a neurosurgeon were too long. Fortunately, he was able to get appropriate treatment in Buffalo, NY.

Health Insurance in the United States
[Online article] This informative article covers the development of the U.S. health insurance system and its growth in the twentieth century, including the development of Medicare and Medicaid. It also examines the role of government policy in setting the stage for nationalized health care.

The History of Health Care Costs and Health Insurance“:
[Online article] This report was written by Linda Gorman, who is a health-care economist at the Independence Institute in Golden, CO. In this article, she covers the history of spiraling health care costs and government control of medical care, and shows how bad laws and other government interference in medicine have led to the current problems. She also offers some positive market-based alternatives to socialized medicine which have been proven to simultaneously increase patient outcomes and decrease costs, including Health Savings Accounts (HSA’s), insurance deregulations, etc.

Your Doctor Is Not In: Healthy Skepticism About National Health Care“:
[Book] This book by Jane Orient, MD, is an illuminating and provocative analysis of the immorality and impracticality of government interference in medicine in general, and single-payer systems in particular. Dr. Orient is the Executive Director of the Association of American Physicians and Surgeons.

The Cure: How Capitalism Can Save American Health Care“:
[Book] This book was written by Dr. David Gratzer, a physician who has practiced in both the US and Canada, and has first-hand experience with the pros and cons of both countries’ medical systems. His documentation of the long waiting lists in Canada and the higher mortality rates for treatable conditions is chilling. He also provides excellent historical background on how health insurance became linked to employee benefits as a result of bad IRS policies, with all the resultant problems. His basic conclusion is that capitalism, not socialism, is the way to address the problems. He offers a number of practical, concrete proposals to fix our current problems, all of which are based on decreasing government interference in medicine.

Podcast interview of Dr. David Gratzer at Instapundit.com:
[Podcast] A 30 minute interview by Glenn Reynolds of Instapundit.com with Dr. Gratzer on the problems and solutions to America’s health care problems.

Universal Health Care — Call It Socialized Medicine“:
[Online essay] Lawrence Huntoon, MD, PhD, discusses why “universal health care” is synonymous with “socialized medicine”. He also observes:

Indeed, “universal coverage,” nationalized health care, or socialized medicine, regardless of what you choose to call it, is not the same as medical care. All of the citizens of Canada, for instance, have “universal coverage.” What they often don’t have, however, is the medical care that they need when they need it. That is why we see Canadians crossing the border into the United States in droves to obtain the health care that they can’t get when they need it in their own country. Their government rations access to health care and thus attempts to control costs by making MRI scans, radiation oncology, bypass surgeries and many other health services largely unavailable to their own people.

Dr. Huntoon is a former president of the Association of American Physicians and Surgeons, and is a practicing neurologist in New York state.

Universal Health Care’s Dirty Little Secret“:
[Online article] Trying to provide universal coverage doesn’t actually result in better care, just rationing.

No ‘Crisis’ of Uninsured“:
[Online article] Rocky Mountain News columnist Mike Rosen debunks the myth that there is a “vast army of people… who are permanently unable to obtain health insurance”.

Why Are Health Costs Rising?“:
[Online article] A nice short analysis on why health care costs have risen so much. Again, the basic problem is government interference in normal market mechanisms. As anyone who has bought a cell phone or a DVD player recently knows, the natural course of the marketplace is higher quality goods for lower prices over time. Even in the medical field, this has been the pattern in LASIK and cosmetic surgery, i.e., in the types of medical care where patients pay for themselves and are therefore incentivized to be prudent shoppers.

Colorado Medical Socialism“:
[Online article] A strong critique of the CMS position on universal mandatory health care by Boulder Weekly writer Ari Armstrong.

There is no health care crisis in Colorado:
From Lin Zinser’s 3/28/2007, “Report on the 208 Commission” (scroll down to her “second point”). She notes, “According to Colorado voters there is no crisis of health care in Colorado. According to Colorado voters polled in December 2006 for the Denver-Metro Chamber of Commerce, 77% of Colorado voters believe their own health care is good or excellent and 60% believe the quality of health care in Colorado as a whole is good or excellent. More to the point, only 7% describe the situation in Colorado health care as a crisis.”

Problems with Tennessee’s universal health care system, TennCare [online articles]:
The Price of Seduction
(A devastating criticism of TennCare from family practice physician, Dr. Sydney Smith.)
Tennessee: Lesson for California
TennCare: A model for how American socialized medicine will fail

Problems with Massachusetts’ universal health care system [online articles] :
Universal Healthcare Boondoggle
Universal Health Care: Proceed with Caution
Intensive Care for RomneyCare
Bad Medicine: What’s Wrong With RomneyCare

Problems with California’s proposed universal health care system [online articles] :
One Step Forward, Ten Steps Back: How California Will Make Health Care Much More Expensive
Schwarzenegger’s Folly
(Analysis by John Stossel, co-anchor of ABC News’ “20/20″.)

Freedom and Individual Rights in Medicine:
[Organization] From their website:

Freedom and Individual Rights in Medicine (FIRM) promotes the philosophy of individual rights, personal responsibility, and free market economics in health care. FIRM holds that the only moral and practical way to obtain medical care is that of individuals choosing and paying for their own medical care in a capitalist free market. Federal and state regulations and entitlements, we maintain, are the two most important factors in driving up medical costs. They have created the crisis we face today.

I encourage all physicians interested in staying informed on these issues to sign up for their mailing list. FIRM also runs a weblog.

The Colorado Medical Society and some key officers:
Alfred Gilchrist (Executive Director): [email protected]
Chet Seward (Director of Health Care Policy): [email protected]
Lynn Parry, MD (President): [email protected]
David Downs, MD (President-Elect): [email protected]
Mark Laitos, MD: [email protected]
Ben Vernon, MD: [email protected]

The 208 Commission official website:
The full list of the 208 Commissioners and the publicly available e-mail addresses:
William N. Lindsay III, Chairman: [email protected]
Erik Ammidown: [email protected]
Elisabeth Arenales: [email protected]
Clarke Becker: unknown
Carrie Besnette: [email protected]
David Downs, MD: [email protected]
Steve Erkenbrack: unknown
Lisa Esgar: [email protected]
Linda Gorman: [email protected]
Julia Greene: [email protected]
Allan Jensen: [email protected]
Grant Jones: [email protected]
Donna Marshall: [email protected]
Pam Nicholson: [email protected]
Ralph Pollock: [email protected]
David Rivera: unknown
Arnold Salazar: [email protected]
Mark Simon: [email protected]
Dan Stenersen: unknown
Steven Summer: [email protected]
Mark Wallace: unknown
Joan Weber: unknown
Barbara Yondorf: [email protected]
Peg Burnette: [email protected]
Donald Kortz: [email protected]
Lynn Westberg: [email protected]

[This letter was slightly edited on 4/17/2007. -- PSH]

FIRM: Freedom and Individual Rights in Medicine

 Posted by on 27 March 2007 at 10:00 pm  Health Care
Mar 272007

Colorado’s political machine is poised to institute socialized medicine in the state in the next year or so. Lin Zinser is fighting that ominous prospect with FIRM, a new organization devoted to promoting Freedom and Individual Rights in Medicine. FIRM’s statement of principles reads:

We stand for Freedom and Individual Rights in Medicine.

America was founded on the principles of freedom and individual rights. Applied to medicine, the law must respect the individual rights of doctors and other providers, allowing them the freedom to practice medicine. This includes the right to choose their patients, to determine the best treatment for their patients, and to bill their patients accordingly. In the same manner, the law must respect the individual rights of patients, allowing them the freedom to seek out the best doctors and treatment they can afford.

Freedom and Individual Rights in Medicine (FIRM) promotes the philosophy of individual rights, personal responsibility, and free market economics in health care. FIRM holds that the only moral and practical way to obtain medical care is that of individuals choosing and paying for their own medical care in a capitalist free market. Federal and state regulations and entitlements, we maintain, are the two most important factors in driving up medical costs. They have created the crisis we face today.

What does FIRM do?

  • researches and studies the work of scholars and policy experts in the areas of health care, law, philosophy, and economics to inform and to foster public debate on the causes of rising costs of health care and health insurance.
  • sponsors and holds public educational programs, lectures and town hall meetings on issues regarding the causes of the crises in health care and health insurance, and on the morality and economic costs of various health care programs and proposals.
  • makes speakers available for radio and television interviews, for professional conferences or symposiums, and for local, private or public meetings and talks in Colorado.

    FIRM provides you with information about how to protect freedom and individual rights in medicine, and you decide how to use it.

    FIRM is a non-profit, non-partisan educational organization; it does not endorse any health care treatment, product, provider, or organization. Membership levels begin at $35 per year and are tax-deductible, as provided by law.

On the FIRM web site, you can sign up to the “News” and/or “Activists” list. You might also want to read the updated version of Leonard Peikoff’s essay “Health Care is Not a Right” and Linda Gorman’ informative report “The History of Health Care Costs and Health Insurance.”

Also, don’t miss FIRM’s blog: We Stand FIRM. (If you have a blog, please add that to your blogroll.)

Please help me spread the word about FIRM! In speaking to ordinary people, I’ve found strong opposition to socialized medicine, but little knowledge of the already-in-motion plans to institute that in Colorado and other states. So please encourage people to write letters to their state and federal representatives opposing socialized medicine, including its modern incarnations in euphemisms: single-payer, comprehensive, universal, and/or mandatory healthcare. If you live in Colorado, you should also write the 208 Commission, i.e. the body charged with soliciting and evaluating proposals for comprehensive healthcare reform.

It is possible to stop the spread of socialized medicine, I think. Now’s the time to do it. If you wait now, you’ll be waiting much more in the future… in lines for your substandard medical treatment, that is.

The Progress of Medicine

 Posted by on 21 February 2007 at 7:45 am  Health Care
Feb 212007

This brief essay from the New York Times on a young girl who had open heart surgery in its infancy in the mid 1960s shows just how much medicine has progressed in the last 50 years. It’s quite remarkable, actually.

Suffusion theme by Sayontan Sinha