On hiatus

So, yeah, I haven't posted in a while. I've lost my mojo, as Austin Powers would say -- finding the motivation to write about health care is really, really difficult at the moment. Diana Hsieh's post, "Blogging in Pursuit of Values," really struck a chord with me.

Hence, ReasonPharm is on hiatus indefinitely, until I get some of the energy and motivation back that I need to sound the alarm on health care.

Asses 'n' elbows, or, why I love CrossFit.

Today in my CrossFit class, we worked handstand pushups. I, of course, do not have the ability to do a handstand pushup yet. Among other things, a handstand pushup takes a certain amount of core and upper-body strength, as well as a certain amount of balance, that I don't yet have.

CrossFit being scalable to various levels of ability, I did not sit out this workout. Instead, the instructor had me work on kicking up into a handstand position (with assistance) and then seeing if I could try at least a few inches' worth of pushup. Didn't happen. Afterward, when the instructor encouraged me to at least try and hold a handstand for a few seconds, I had trouble with even that much. It was a day when I felt like, as another instructor at my gym puts it, "asses 'n' elbows."

"Asses 'n' elbows" is not a new feeling to me. I've never been particularly coordinated. My athletic and highly coordinated husband marvels at how many times I can drop something -- a book, a fork, an iPod -- in the course of a normal day. I was picked last for every team in every gym class, from elementary school all the way through high school. And I'll never forget the first time I took a tango class with my husband. The course claimed to be a "crash course for beginners," but I was sub-beginner; I was so terrible at it that even though there were fewer women than men in the class, one man actually declined to dance with me when his turn came, preferring to go without a partner. OUCH.

So, yeah, I've felt clumsy and inept many times. What I've noticed I do differently since starting CrossFit, though, is how I handle those "asses 'n' elbows" moments.

In school, it stung to be chosen last every. single. time. I'm pretty sure I cried about it at least a few times after school. After that horrible dance experience, it took years of coaxing on my husband's part to get me back into another tango class. (Yes, my husband, not I, is the one who always wanted to learn to tango.) Hell, even in the first few weeks of CrossFit I found myself feeling ashamed for doing light weights compared with the other girls, or having trouble mastering a movement (snatch, anyone?).

But the great thing about CrossFit is that you get better, and you can measure how much better you're getting. My gym likes to do what they call "strength cycles," in which we'll focus on the same set of movements for four weeks, getting a little stronger and better at those movements each time. The strength cycle before this one, we focused on the clean. I stank at it the first time I tried it. The clean has quite a few moving parts; every time I remembered to keep the bar close to my body, I'd let my feet drift too wide in the squat, or I wouldn't get my elbows far enough forward, or something. Yup, asses 'n' elbows again.

I kept trying to clean, though, and by my third exposure to the movement, I was able to start adding weight, even though I wasn't exactly nailing every aspect of it. And on the fourth and final exposure, something crazy happened: I stopped feeling like a klutz. The clean came smoothly that day. I still have a long way to go -- you won't be mistaking me for an Olympic lifter any time soon -- but for the most part, I was getting it right and feeling good about it.

That was, I think, a defining moment in my CrossFit experience. Now, when I feel all klutzy, I can think back to that day and remember that, as much as it sucks to feel like asses 'n' elbows, it's just a step on the way to mastery and confidence. And that's why today's experience, which might have made me cry just a few months ago, felt so different. No, I was not coordinated or good at this movement in the least -- but that didn't bother me. (And it didn't hurt that my gym is full of encouraging people who are not at all like the schmuck who wouldn't dance with me in that tango class.)

Here's to embracing the process of getting fitter and stronger, even the awkward bits!

No, I do not want to write you a check for $1,000,000

I don't care if you're somebody's grandma; I don't care if you've never been able to hold a job that paid more than $20K a year; I don't care what your health problems are. I don't want to pay for your Social Security and your Medicare. As John Cogan puts it in today's Wall Street Journal, Medicare and Social Security are like handing a million-dollar check to every elderly couple -- except your name and mine are on the payer line.

Cogan rightly points out that there's going to be some pain involved in cutting back entitlements. (He doesn't seem to advocate eliminating them altogether, which is what we really should be doing -- but scaling back would be a start.) Yes, some seniors who've already paid into the system are not going to get everything they paid for. That's unavoidable because, as Cogan says, the money's already been spent; the Ponzi scheme can't go on forever, nor even for very much longer.

I know that if Social Security and Medicare are eliminated, as they should be, I myself will have paid tens of thousands of dollars, probably well over six-figure sums by the time such a thing should happen, into the system, not a cent of which I will recover. This pisses me off, but I would rather that, than that we continue to violate the right of every individual to keep and dispose of his own property, and than that I get soaked for even bigger sums that I won't get back.

To answer Mr. Cogan's question -- no, I don't want my children to be the ones backing that million-dollar check. I don't even want to be the one backing that check. Instead, we should be allowed to keep what we earn, so we can all plan and save for our own retirement.

Doing healthcare reform right: Safeway

THIS is how you ACTUALLY lower healthcare costs: by tying them to people's choice! Safeway CEO Steven Burd writes in the Wall Street Journal that his company's policy of financially rewarding workers who don't smoke, maintain a healthy weight, and otherwise cost less to insure has paid off in terms of lowering healthcare costs for the company. In fact, Burd would like to offer more behavioral incentives to his employees -- the $312 he is allowed by law to pay each worker for not smoking is far less than the $1,400 extra it costs to insure a smoker vs a nonsmoker, so he'd like to make that incentive even bigger to get more employees on the wagon.

As Burd says, Safeway's ideas are not new; they're borrowed from the auto insurance industry, which does not require good drivers to pay more to subsidize payouts for bad drivers. As with driving a car, one's health is in large part under one's direct control. Why shouldn't the market reflect that by rewarding those who take responsibility for their health and punishing those who don't?

It's ironic that the same liberals who want to force "predatory lenders" to have more "skin in the game" -- that is, more of their own money at risk -- don't think the same way about health. It certainly doesn't seem to bother many Americans that their literal skin (and internal organs, and teeth, and eyes, etc.) is in the game when it comes to taking care of their health. Why shouldn't each of us have some financial skin in the game as well? And why wouldn't insuring everybody at the same price, regardless of health conditions, encourage self-destructive behavior?

From gag rule to speech at the point of a gun

In Atlas Shrugged, the apes in power try to make a productive man say what they want him to say by holding a gun to his back -- and the FDA is now doing the same thing to the makers of painkillers. (Thanks to Jared Rhoads of the Lucidicus Project, from whom I first heard about this story.)

The FDA has its knickers in a twist because prescription painkillers are often used, not for the purpose for which they are prescribed, but to get high. Because our nanny state can't possibly allow a man to make his own choice about what he puts into his own body, and to bear the consequences if he makes a mistake, the FDA is joining the DEA (and probably other alphabet agencies) in trying to stamp out prescription painkiller abuse.

The issue that FDA wants addressed is that the vast majority of prescription painkiller users do not get the drug because it was prescribed to them by a doctor. They get it from a dealer, or because someone they know was prescribed the pills and passed them on.

So FDA's solution is to force the manufacturers of opioid painkillers to develop anti-abuse education materials. These materials are supposed to persuade the patient for whom the drugs are actually prescribed not to give them away, and to educate the doctor on how to talk to patients and/or recognize that a drug he's prescribing may not be going to the patient it's being prescribed for.

Never in this process is it assumed that a) the patient has a brain, probably knows that opioid painkillers have addiction potential (duh!), and knows exactly what he is doing if he decides to supply drug to someone else; b) the doctor wasn't born yesterday (but also is under huge time constraints imposed by our current healthcare system, itself the result of government regulations, and therefore may not have time to ask all the questions required to determine whether a patient is really in pain or is a "drug seeker"); and c) that all parties involved, including the drug abuser, have a right to enter into whatever mutual agreements they please, including agreements that result in someone getting high on pain pills!

Instead, the FDA is holding a gun to manufacturers' backs and telling them they have 120 days to produce educational materials (which, according to the agency's logic, will surely cause patients, sheep-like, to stop handing drugs to their friends and family) and submit them to the agency. (The gun, of course, is the unspoken but palpable threat that FDA will force manufacturers to pull these products from the market.) As Jared Rhoads has pointed out, 120 days is just about enough time, should the manufacturers start working feverishly right now, to get the materials reviewed by their internal legal and regulatory personnel. Then the FDA gets to look at the materials and force the manufacturers to make additional changes as it sees fit.

Unfortunately, unlike in Atlas Shrugged, the manufacturers are not reacting by pointing out the gun at their backs for what it is, and proudly standing up for their right to sell their products without government interference. In fact, one manufacturer's representative meekly says, "We really support [FDA] efforts...we think education is the right way to tackle this issue," as the Wall Street Journal reports. Not that I can condemn them for it -- as Ayn Rand said, morality ends where a gun begins, and these producers recognize that they risk losing their entire operations should they fail to comply with the FDA's demands. But I can condemn the FDA for trampling on the rights of producers and patients alike.

Another gag rule from the FDA

I've already posted many times about how FDA gags pharmaceutical companies -- preventing them from making many kinds of claims, even if true, about their products. But I didn't know until today that the FDA's coercive power extends to journalists as well -- the agency forbids reporters from consulting outside experts with regard to embargoed news.

Let's talk about what a news embargo is, first. A company or organization wants certain news released, but it wants to control the timing of when that news is released. So it enters into voluntary agreements with reporters: You get the scoop in exchange for promising not to release that news until an agreed-upon date. So far, so good; we have a voluntary agreement between reporters and companies or trade groups. (We'll leave aside the case that the need for an embargo may have arisen because of an FDA requirement that a company not publicize its offerings prior to a certain date; in that case, the FDA is clearly violating rights, but the embargo itself remains a voluntary agreement.)

But the FDA has decided to meddle with this process, forbidding reporters to consult with third-party experts about embargoed news. This means that the reporter, who is likely a well-educated layman with respect to the drug or device he's reporting on, is not allowed to verify the story he's about to print with someone who is more qualified to evaluate the claims being made. As the Association of Health Care Journalists puts it, "Reporters who want to be competitive on a story will essentially have to write only what the FDA wants to tell the world, without analysis or outside commentary." That's a clear violation of free speech.

The FDA needs to butt out of healthcare communications entirely. It's scary that the arm of the state reaches beyond forcing pharmaceutical companies and medical device makers to denounce their own product, and into making the press say what it wants.

How insurance encourages us not to ask questions: An example

[Warning: slightly icky medical details follow.] I have a plantar wart. If you've never had the pleasure of dealing with one (I've read that about 15% of Americans have), allow me to inform you that a plantar wart is what happens when HPV decides to take up residence somewhere on the sole of your foot. The warts HPV causes in this way are not really painful, but they can be uncomfortable. They are also tenacious as all get out. All kinds of over-the-counter remedies exist for getting rid of plantar warts. Often, as has been the case with me, they don't work. After trying and failing to kill the little bastard son of a bitch darn thing for six months with OTC salicylic acid patches, I finally gave up and headed to a podiatrist.

Podiatrist has a look at my foot, confirms that I indeed have a plantar wart, and informs me of the stronger options available to treat such things when there's a prescription involved. Fine. (Well, except for the hour and a half beyond my scheduled appointment time I had to wait to see him, which is an example for a different argument against government regulation in health care...but that's for another day.)

At this point, the doctor told me he would shave off part of the wart so that the medication he prescribed me to put on it would be absorbed more efficiently. He took out his scalpel and scraped for about 30 seconds. I thought nothing of this at the time. But, a few days ago, I got my insurance company's "explanation of benefits," a statement I receive any time I visit a doctor or hospital. The EOB, as they abbreviate it, explains what services I received from the doctor, how much the doctor billed the insurance company, how much the insurance company actually paid out (since, frequently, they negotiate lower rates than the doctor initially bills), how much of a copay I had, and if there's any further obligation on my part to pay the doctor. (Usually, since I have a pretty generous insurance policy, there isn't.)

When I got the EOB for the podiatrist visit, I saw that the doctor had billed about $150 for a "visit" and gotten paid the negotiated rate of $75. He also billed the insurance company $100 for "surgery," and got paid $53. It took me several minutes to figure out that this "surgery" was the 30 seconds' worth of shaving he'd done to my foot in the office! Would I have paid $53 for this service, let alone the requested rate of $100, if I were paying for my medical care directly? Oh, hell, no. It's something I easily could have done myself, at home, for the price of an Xacto knife. I'll admit, I probably wouldn't have thought to ask the doctor the price of such a simple "operation" before he performed it, but if he had had the nerve to try and charge me that much for it, I would have argued and, if he insisted on charging me in the end, I could have refused to see him for any further care and posted a negative review on one of the many ratings websites out there.

In any case, there would have been much more pressure on the doctor -- whether from me or from patients who'd seen him before me -- to put a much lower price on such a small service. Instead, there was no incentive at all for the doctor to charge a low price, or for me to question the bill afterward. After all, I'm not paying it -- my insurance company is. Except that, when this kind of decision is made by millions of people, guess what? Premiums go up!

Remember, we owe this distorted system to the tax policy that makes it advantageous for our employers to buy us generous health benefits rather than raising our salaries. In a free market -- free of coercive taxation -- most of us would likely buy far less comprehensive health care policies in order to save money, and then we'd scrutinize our health care expenses far more closely in order to save more money.