John LaPlante
John R. LaPlante is the managing editor of both the StateHouseCall blog and the State Policy Blog. Mr. LaPlante has written on a range of public policy issues since 1998, including health care and education. His writing credits include the Detroit News, the Minneapolis Star-Tribune, the Saint Paul Legal Ledger, and the Wichita Eagle. He holds an M.A. in political science from The Ohio State University.
Friday, July 18, 2008No More Protons, Please!By John LaPlanteCategories: Certificates of Need (CON), IllinoisWho can fathom the number and scope of regulations surrounding health care? This morning I read that something called proton therapy is a new form of treatment for cancer. (It's an alternative to or perhaps an enhancement of radiation therapy.) There are five facilities in the country that offer this therapy. Northern Illinois University has permission to start another one, which it says will be finished in March, 2010. In April, the state's health facilities planning board blocked a move by Central DuPage Hospital to build a similar facility. One reason for the denial, perhaps, is that the two centers would be only 6 miles apart. Yet Chicagoland is one of the leading metropolitan areas in the country, so why--if you care about such things--shouldn't two facilities be sustainable? DuPage County, by the way, is in the 25 wealthiest counties in the country, so I expect that residents will demand the best services available--including new treatments. The hospital's proposal is now being championed by 23 state lawmakers, who are pitching an appeal to the state regulatory board. Imagine that your state senator's political power made the difference in the opening of a new medical clinic. That's the prospect of increasing the amount of power that government has over health care.
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Friday, July 18, 2008Can Ignorant Consumers Still Buy Health Care?By John LaPlanteCategories: Medical TourismIs health care so complex that it must be entrusted to experts, such as people in government agencies? The blotter behind Healthcare Manumission says no: "There is indeed an asymmetry of information in medical care. That much is indisputable. There is also an asymmetry of information in law, auto repair, computer technology, and countless other realms where we yield to the wisdom of those we consider experts." And yet we don't expect government to organize an "automobile maintenance organization." Nope, consumers figure their way around in markets all the time--and health care is not excluded.
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Thursday, July 17, 2008The Other Crisis Affecting Health CareBy John LaPlanteJohn Joseph Leppard IV, who blogs at Healthcare Manumission, says there is an insurance affecting health care in America: "'I'm referring to malpractice liability insurance. Although generally considered an issue which affects just the small, "elite" physician community, the current state of malpractice liability insurance has far reaching implications which are significant and consequential to the entire state of the American health care system." Malpractice insurance is a factor, he argues, even though few disputes go so far as to result in an award for the plaintiffs. Defending a charge can cost anywhere from $25,000 to $90,000, and sometimes more, he says. The results of soaring costs: some doctors leave the practice. Others change their ways of providing medicine--and not always to the benefit of anyone.
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Thursday, July 17, 2008"I'm Proud to Have Killed Off People's Livelihoods"By John LaPlanteCategories: Nanny StateIt may seem strange to oppose a smoking ban on a site dedicated to health care policy, but I'm going to try. The case for smoking bans may seem a slam-dunk. Smoking is bad for human health, though not all who smoke develop cancer or other diseases, and some people develop lung cancer and so forth without ever having lit a cigarette. But there are other important ideals that get trampled in the rush to smoking bans. One is freedom of association, or your ability to patronize or work at an establishment based in part on whether it allows smoking. Another is property rights, or the ability of a business owner to allow acts, legal otherwise, on his property. One smoking ban advocate writing in a Minnesota newspaper, however, says rights be damned: "I am not going to debate what is in the Bill of Rights we all hold so dear." In other words: I don't care what the Bill of Rights says. As a friend of mine puts it, "Some of us, obviously, hold it a little more dearly than others." Smoking bans, prohibitions on trans fats in restaurant foods and health care policies that rely on pay-or-play, individual mandates or at the extreme, outlawing private health insurance, are of the same cloth, trampling personal rights in the name of the public good.
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Wednesday, July 16, 2008An 18-Month Wait for Rate ApprovalBy John LaPlanteCategories: Insurance Regulation, MichiganThink that we've got a free market in health care? Not entirely. Here's one example: Blue Cross Blue Shield of Michigan w anted to increase the rates it charges customers in the individual market. In a normal market with a normal company, BC/BS would analyze business conditions, assess the competition and consumer demand, and act accordingly. But BC/BS is not a typical business and insurance is not a typical market. For one thing, the company (as with all insurance companies selling individual insurance, I believe), had to beg a government agency for permission. In this case, it's up to the state's insurance commissioner to decide. So BC/BS submitted their paperwork. That was 18 months ago. Ken Ross, the commissioner, denied the company's request. And he didn't say what would be an acceptable rate, leaving the company to guess and try again. IF we're going to subject a business to regulatory approval, the response of government ought to be quick, with clear guidance accompanying any "no" vote.
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Wednesday, July 16, 2008Great for Thee, but Not for MeBy John LaPlanteCategories: MassachusettsWhat does the population of Massachusetts think of the state's "universal" health care plan? The answer depends on one's familiarity with the situation. The Boston Globe says: "More than two-thirds of Massachusetts residents support the state's two-year-old, near-universal health insurance law, according to a new poll, but consumers most directly affected by the law are significantly less enthusiastic." Support for the law, as suggested by the poll, is 69% overall, but substantially less (52%) of people who have actually been in the insurance market because of it. More significantly, it appears that people are waking up to the ill effects of the law: "he percentage of those who think the uninsured are being hurt by the new law nearly doubled from 17 percent last year to 33 percent this year." There's still a lot of "free lunch" or "tax someone else" understanding, with raising the cigarette tax being a favorite option for covering the inevitable shortfall. (So much for a program that saves money!)
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Wednesday, July 16, 2008The Nanny State Continues: No Trans Fats for YouBy John LaPlanteCategories: California, Nanny StateWhatever happened to "keep your hands off my body?" I know that's from the abortion debate, but it's certainly something that would be useful to remember as governments play chef. The latest comes via the San Francisco Chronicle: "California is poised to become the first state in the nation to ban restaurants and other food facilities from using trans fats, which are known to increase the risk of heart disease, under a bill approved by the state Legislature Monday and sent to the governor." Think you've got nothing to worry about if you live outside the Fruits and Nuts state? Think again. The ban does not apply to packaged goods that are sold across state lines, but already advocates are calling on Congress to enact such a ban. And of course they'll use the "enlightened" policies of California as an example to follow.
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Tuesday, July 15, 2008Government CrowdoutGM to retirees: Turn to government By John LaPlanteOne problem with government-run health care plans is that they tend to displace private-sector action. The latest example is General Motors, which is dropping health care coverage for salaried retirees. The obvious reason is that the company is on its death bed. But the fact that there's a government program at hand--in this case, Medicare--makes the move palatable.
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Monday, July 14, 2008Six Tips to Using Your HSABy John LaPlanteCategories: HSAs, etc.This morning the Wall Street Journal (subscribers' link) has six tips on using your HSA. Jane Zhang says that it's easy to "make costly mistakes regarding unnecessary fees and tax surprises." The tips:
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Saturday, July 12, 2008Romney on RomneyCareBy John LaPlanteCategories: Individual Mandates, Insurance Regulation, MassachusettsMitt Romney, former governor of Massachusetts, reflects on that state's one-year old health-care program. He praises the Bush Administration for granting a Medicaid waiver that enabled the program to get underway. He lauds the program, despite the criticism it has received here and elsewhere, saying for Bay State residents, "there is no more worrying that if you lose your job, you lose your health insurance." Romney points out that through Commonwealth Care, people making less than 300% of the federal poverty level buy insurance on their own, with pre-tax dollars. On their own, pre-tax? That's good. Romney offers several items of praise for the program: Lower-than-projected costs, increasing the number of people with insurance, and having "tackled the free-rider problem." He then gives several "mid-course corrections," including requiring that everyone in the program pay something.
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