Tag Archives: health care

Leading from Behind

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…and continuing the Obama administration meme of letting the “international community” dictate our foreign policy—and now our domestic policy, also.

A quarantine against travel from the Ebola-infected nations of western Africa to the United States, ideally as part of an international effort but plainly not dependent on it, is critical to mitigating the risk to the United States of the Ebola epidemic spreading to here. I’ve answered the CDC chief’s objections to a travel ban here and here. Others more knowledgeable than me also are calling for such a travel ban.

Here, though, is what Obama’s State Department—medical experts all—claim in all seriousness:

“We are not imposing any sort of ban,” a State Department official told FoxNews.com. “We need to allow for this to be a global response and make sure that there is proper care and training throughout the region.

Because, it’s not perfect, therefore mustn’t do it at all. Because, safety in numbers, especially if those numbers give cover for avoiding responsibility for error. Because, it might show initiative. Because, leading from the front is arrogant.

The most likely global response from this foolishness is an Ebola pandemic.

It just isn’t the Democrat way to accept responsibility and the personal risk that entails.

It just isn’t the Democrat way to be out front, with or without the “international community.”

It just isn’t the Democrat way actually to lead.

Another Reason for Smaller Government

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Even with lives at stake—lives in the middle of a budding pandemic—Big Government bureaucracies are more interested in protecting turf and responsibility ducking than they are in their fundamental task of protecting American citizens’ safety from foreign problems.

Worse, one of the bureaucracies involved in this cynical ego-based Federal road block has nothing to do with the medical questions involved. First, the experts, at least by training and experience, if not by smooth performance:

The hazardous waste protocols in place for hospitals require staff to place any potentially infected substances—whether it is medical equipment or protective gear—into special hazardous waste containers. That waste then is supposed to be turned over to licensed hazardous waste companies, where it is incinerated or chemically sterilized, according to the CDC.

However, because that other Big Government agency thinks it must have something to say about handling hazardous medical waste, we get this [emphasis added]:

Due to specific Ebola-related regulations issued by the US Department of Transportation (DOT), which governs what medical waste companies can and cannot transport, the usual waste haulers or medical waste disposal companies are prohibited from accepting Ebola-contaminated waste until it has been properly packaged in accordance with DOT guidelines.

And so we get this problem, delineated by [Dr Jeffrey, National Global and Public Health Committee Chairman for Infectious Diseases Society of America] Duchin:

The medical waste companies are refusing to come and pick up the waste because of the DOT regulations, which the CDC does not agree with.

Never mind that the sole experts in the matter, the CDC, has said the Ebola waste ready for safe handling by medical waste companies.

Just to add to this ego-ridden fiasco, we also have this, demonstrating that it’s not only the Federal government that’s gotten too big, too turf-ridden, with too many egos embedded:

[A] Louisiana waste disposal facility, Chemical Waste Management Inc-Lake Charles, says it will not accept the ashes generated when Duncan’s belongings were incinerated, at least not until state officials agree that it would pose no threat to the public.

And this nonsense: The Louisiana Attorney General, Buddy Caldwell, has sued in state court to block the transportation of the waste to the Calcasieu Parish facility (the waste disposal facility in question), and a Louisiana state judge has agreed and blocked the shipment. Because these guys—a state government lawyer and the state government’s judge—know better.

These are yet others reason for shrinking government.

Obamacare and Health Care

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As Dr Scott Atlas, of Stanford University’s Hoover Institution, in a recent The Wall Street Journal op-ed noted,

  • Private company medical innovation R&D spending in the US the last three years averaged 2.1%, down from an average of 6% over the previous fifteen
  • Malaysia, Thailand, Singapore, South Korea, India, and the EU had greater R&D spending growth in the same period
  • The PRC had a growth rate of 22%

Certainly, those other polities, the EU excepted, were starting from a much smaller base, and so their growth rates will tend to be exaggerated. Certainly, too, our own historically weak economy is exacerbating the situation.

All that notwithstanding, though, this is a trend that is allowed to continue at the peril of our leadership in things medical. Obamacare, with its removal of the insurance aspect of health plans, actively hurts this. What plan can pay for the latest and best drugs or devices, and so drive innovation—or even those drugs or devices that are merely near the cutting edge, or that are middle tier—when those plans aren’t allowed to recoup their costs, except at generalized taxpayer expense?

There’s one aspect, though, that is a direct assault on medical innovation, and that’s Obamacare’s medical-device excise tax. This is a tax the takes 2.3% off the top—that is, before expenses and profit—of all medical device sales. This includes devices from heart pace makers to dialysis units to bandages sold in bulk to hospitals.

2.3% is no big deal?

  • Johnson & Johnson’s medical device and diagnostic sales were down 1.5% in the US, versus up 1.8% internationally, in the first half of 2014
  • General Electric reported that the US healthcare sales shrank by 2% in the second quarter, versus up 2% in Europe
  • Medtronic’s US sales for the 2014 fiscal year were up 1.7%, versus 5.9% internationally
  • Baxter reported US sales of medical products were down 15% for the quarter ended June 2014, versus up 8% globally
  • Fresenius’ US sales of dialysis products were down 1.2% in the first half of 2014, versus up 0.6% internationally

And (via the first link above)

Boston Scientific, Stryker, and Cook Medical have announced job cuts and plans to open new centers for R&D, manufacturing, and clinical trials overseas.

And so on.

Many attempts have been made to repeal this pernicious tax, the latest this past summer. The Democrat-controlled Senate refused to consider it. Again.

In Which another Federal Judge Gets it Right

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Recall Halbig v Sebelius, the case wherein plaintiffs objected to subsidies being paid to Obamacare plan purchasers when the those plans were bought through ObamaMart, the Federally run health plan exchange, instead of through State-run health plan exchanges. The text of the Obamacare law allows the latter and bars the former. The DC Circuit agreed with plaintiffs and struck down the subsidies. (The current status of that ruling is that it’s been stayed pending review of Halbig by the DC Circuit sitting en banc.)

US District Judge Ronald White, of the Eastern District of Oklahoma, has ruled on a similar case that came up in his district, a part of the 10th Circuit. I won’t go into the specifics of Pruitt v Burwell, White’s case; the cases are very similar, and the point I want to make here is slightly different, anyway. I will note that plaintiff Pruitt is Oklahoma Attorney General Scott Pruitt, and defendant Burwell is Sylvia Mathews Burwell, HHS Secretary (sitting in for Kathleen Sebelius under an arcane Federal rule that allows such things). I will note further that Treasury Secretary Jacob Lew also was a defendant in this case, and leave things there.

White ruled for the plaintiff, which means he also held that the subsidies paid to Obamacare plan purchasers who bought them through ObamaMart are illegal.

Here’s where things get interesting.

In his conclusion, White wrote [citations omitted, emphasis mine]

Other judges in similar litigation have cast the plaintiffs’ argument in apocalyptic language. The first sentence of Judge Edwards’ dissent in Halbig is as follows: “This case is about Appellants’ not-so-veiled attempt to gut the Patient Protection and Affordable Care Act (‘ACA’).” Concurring in King, Judge Davis states that “[appellants’ approach would effectively destroy the statute….” Further, “[w]hat [appellants] may not do is rely on our help to deny to millions of Americans desperately-needed health insurance….”

And

Of course, a proper legal decision is not a matter of the court “helping” one side or the other. A lawsuit challenging a federal regulation is a commonplace occurrence in this country, not an affront to judicial dignity. A higher-profile case results in greater scrutiny of the decision, which is understandable and appropriate. “[H]igh as those stakes are, the principle of legislative supremacy that guides us is higher still…. This limited role serves democratic interests by ensuring that policy is made by elected, politically accountable representatives, not by appointed life-tenured judges.”

And

This is a case of statutory interpretation. “The text is what it is, no matter which side benefits.” Such a case (even if affirmed on the inevitable appeal) does not “gut” or “destroy” anything. On the contrary, the court is upholding the Act as written. Congress is free to amend the ACA to provide for tax credits in both state and federal exchanges, if that is the legislative will. … “But in the last analysis, these always-fascinating policy discussions are beside the point. The role of this Court is to apply the statute as it is written – even if we think some other approach might ‘accor[d] with good policy.’“

Finally, quoting from a ruling by his own 10th Circuit appellate court,

In reviewing statutes, courts do not assume the language is imprecise…. Rather, we assume that in drafting legislation, Congress says what it means.

And that’s the deal. A law says what Congress—the People’s directly elected representatives—says it says. A judge, or any appellate court at any level of our judicial hierarchy, can only apply that law to the case before him. Most especially, he cannot rewrite the law or “creatively interpret” it into something more agreeable to his personal philosophy.

Oh, and just to saucer and blow the thing, White formally ruled pretty clearly:

The court holds that the IRS Rule [allowing those subsidies] is arbitrary, capricious, an abuse of discretion or otherwise not in accordance with law, pursuant to 5 USC §706(2)(A), in excess of statutory jurisdiction, authority, or limitations, or short of statutory right, pursuant to 5 USC §706(2)(C), or otherwise is an invalid implementation of the ACA….

Judge White’s ruling can be seen here.

 

h/t Jonathan Keim of the National Review Online