Category: Regulations

Healthcare Innovations Can Be Effective AND Cheap

Many are resigned to accept our current mess of a healthcare system because they fear that if the system was changed into a fully free market system they would not be able to afford anything approaching their current level of healthcare. But they do not understand what would change. If patients paid for their own healthcare there would be competition to provide cheaper healthcare services to the many. Henry Ford got rich finding ways to make cars better and cheaper. Bill Gates got rich mainly by making adequate operating systems cheaper.

If we made healthcare a free market, then healthcare would find its Henry Ford and Bill Gates. If patients directly paid for healthcare, then healtcare services would be more consumer oriented–for instance the value of patients’ time would be respected. Medical entrepreneurs would compete to bring us more cures and cheaper cures.

The problem is not that we are “fixated on profits” as is suggested in the last paragraph quoted below. The problem is that our non-market healthcare system creates perverse incentives and perverse regulatory constraints, so that simple frugal innovations are not rewarded.

[Below I first quote a few passages from The New York Times obituary of Cash, and then from The Wall Street Journal obituary of Cash.]

(p. A21) Richard A. Cash, who as a young public-health researcher in South Asia in the late 1960s showed that a simple cocktail of salt, sugar and clean water could check the ravages of cholera and other diarrhea-inducing diseases, an innovation that has saved an estimated 50 million lives, died on Oct. 22 at his home in Cambridge, Mass. He was 83.

. . .

Dr. Cash, the son of a doctor, arrived in East Pakistan, today Bangladesh, in 1967 as part of a project through the U.S. Public Health Service. There he worked with another young American doctor, David Nalin, to respond to a cholera outbreak outside the capital, Dhaka.

The two had already been researching a simple oral rehydration therapy and knew of other, previous efforts, all of which had failed. But they believed that the therapy held promise, especially in the face of mounting deaths.

They realized that a main problem was volume: Past efforts had resulted in too little or too much hydration. Dr. Cash and Dr. Nalin conceived a trial in which they carefully measured the amount of liquid lost and replaced it with the same amount, mixed with salt and sugar to facilitate absorption.

They divided 29 patients into three groups, with one group receiving an IV drip, another an oral treatment through a tube, and the third an oral treatment by drinking from a cup.

Other doctors and nurses found their experiment bizarre and tried to stop them. But Dr. Cash and Dr. Nalin persisted, splitting the work between them in two 12-hour shifts, to ensure the integrity of the trial.

The results were definitive: Only three of the tubed patients — and only two who drank the solution — needed additional IV treatment.

. . .

“We’re enamored by high technology,” he said at the Council on Foreign Relations. “And we’re not in love with low-tech. Low-tech is always seen in our eyes as second-class. Why would you do this, when you could do that? And I would argue just the opposite.”

For the full obituary from The New York Times that is quoted above, see:

Clay Risen. “Richard A. Cash, 83, Who Saved Millions From Dehydration, Dies.” The New York Times (Monday, November 4, 2024): A21.

(Note: ellipses added.)

(Note: the online version of the obituary has the date Nov. 2, 2024, and has the title “Richard A. Cash, Who Saved Millions From Dehydration, Dies at 83.”)

(p. C6) Half a liter of water, plus a pinch of salt and a fistful of sugar. As scientific insights go, it can’t compare to the intricate equations developed to split the atom or map the planets’ paths. But its simplicity was crucial to its monumental impact.

That simple solution—the cornerstone of Oral Rehydration Therapy, or ORT—has proved extraordinary in staving off and reversing the devastating consequences of dehydration caused by cholera and other diarrheal diseases, saving tens of millions of lives since its development nearly six decades ago. In 1978, an editorial in the Lancet called ORT “potentially the most important medical advance of the century.”

. . .

Cash saw this ethos of simplicity and accessibility as instructive for a western medical system that’s infatuated with high-tech solutions, dismissive of low-tech ones and fixated on profits—and where, consequently, an overnight stay in the hospital for dehydration can result in a four-figure bill. “A solution that can’t be applied,” he told Harvard Magazine, “is really no solution at all.”

For the full obituary from The Wall Street Journal that is quoted immediately above, see:

Jon Mooallem. “A Doctor Whose Simple Treatment Prevented Millions Of Cholera Deaths.” The Wall Street Journal (Saturday, Nov. 9, 2024): C6.

(Note: ellipsis added.)

(Note: the online version of the obituary has the date November 7, 2024, and has the title “Richard Cash, Whose Rehydration Therapy Saved Millions of Lives, Dies at 83.”)

Regulators Do Not Understand the Sense of Urgency of Some Who Are Dying

Many know that the first gift of Prometheus to humanity was fire. Fewer know that his second gift was blind hope. International value surveyor Ronald Inglehart concluded that happiness depends less on current status than on hope for the future.

Many who are facing death without any standard therapy to save them, are anxious to try a Hail Mary experiment–a potential therapy with many risks, but with a possible path forward, with hope.

A libertarian or classical liberal says that they have the right to choose hope.

In the concluding passages quoted below it is easy to sense the hope that the pig kidney transplant gave Tawana Looney.

(p. A18) A 53-year-old Alabama woman with kidney failure who waited eight years for an organ transplant has received a kidney harvested from a genetically modified pig, NYU Langone Health surgeons announced on Tuesday [Dec. 17, 2024].

The patient, Towana Looney, went into surgery just before Thanksgiving. She was in better health than others who have received porcine organs to date and left the hospital 11 days after the procedure.

. . .

Dr. Robert Montgomery, director of the NYU Langone Transplant Institute, co-led the surgery with Dr. Jayme Locke, a transplant surgeon who applied two years ago for approval from the Food and Drug Administration to perform the operation for Ms. Looney.

. . .

The experimental procedure was approved by the Food and Drug Administration under its expanded access or compassionate use program, which allows unapproved products to be used when patients have life threatening conditions.

. . .

About two years ago, Dr. Locke contacted Ms. Looney. Dr. Locke was intent on finding better solutions for patients with kidney failure, which is rampant in Alabama and disproportionately affects the state’s Black residents.

It was the beginning of a conversation that spanned nearly two years while the physician sought special F.D.A. permission to do the xenotransplant on Ms. Looney, who was eager to get started.

“I said, ‘OK, where do I sign?’” Ms. Looney recalled.

“But she said, ‘This is new territory. This is new ground. I don’t know what might happen, and a lot of things could go wrong here.’ I said, ‘OK, when are we going to do it?’ And she went through all the if’s and and’s and what might happen again.”

The dialogue continued on and off for months. “We talked every day, and every day we talked she said, ‘Are you sure?’ And I said, ‘I’m positive. My mind is made up,’” Ms. Looney said.

Last month, while Ms. Looney was sitting in her dialysis chair during her morning treatment, her phone rang. It was Dr. Locke, who asked, “How do you feel about flying up to New York?”

Dr. Locke explained that she would do the surgery with Dr. Montgomery, the mentor who trained her.

“I said, ‘But what about Christmas? What about Thanksgiving?’ ” Ms. Looney said.

“She said, ‘It is going to be the best Christmas present you ever got.’ I said, ‘Yes, ma’am, it is.’”

For the full story see:

Roni Caryn Rabin. “Alabama Woman Gets Nation’s 3rd Pig Kidney Transplant.” The New York Times (Wednesday, December 18, 2024): A18.

(Note: ellipses, and bracketed date, added.)

(Note: the online version of the story has the date Dec. 17, 2024, and has the title “Alabama Woman Receives Nation’s Third Pig Kidney Transplant.”)

Chinese Communist Regulators Will Want to Deep-Six DeepSeek

Many policy experts have worried than China’s economy will surpass the economy of the United States. If we lived in a world of totally free trade, I would not care if this happened. Economics is not a competitive sport where one team can win only if another team loses. A free economy is not a zero-sum game. If you are OK with me mixing metaphors: a rising tide really does lift all boats. (Amar Bhidé (quoting Paul Krugman, if memory serves) does a good job of making this point in The Venturesome Economy.)

But even though it wouldn’t bother me, China’s economy will not surpass that of the United States if China continues to oppressively regulate its economy and we continue to exuberantly unregulate our economy. An economy thrives when entrepreneurs thrive and entrepreneurs thrive when unregulated.

Consider the recent hand-wringing over the recently announced DeepSeek Chinese A.I. program. The Chinese Communists will be especially energetic in regulating entrepreneurs in the A.I. sector because the Communists cannot afford to have Chinese A.I. programs giving true answers to questions in any way related to the Chinese economy, or to the corruption and authoritarianism of the Chinese Communist regime. A.I. policy expert Barath Harithas understates the situation when he says: “Overregulation and the need to adhere to ‘core socialist values’ could risk neutering A.I.’s potential” (as quoted in Pierson and Wang 2025, p. A4).

Barath Haritas’s statement on overregulation of A.I. in China can be found in:

David Pierson and Berry Wang. “Success of DeepSeek Lifts China, but Party May Halt Its Progress.” The New York Times (Tues., February 4, 2025): A4.

(Note: the online version of the article has the date February 2, 2025, and has the title “DeepSeek Is a Win for China in the A.I. Race. Will the Party Stifle It?”)

The book by Amar Bhidé that I praise in my initial comments is:

Bhidé, Amar. The Venturesome Economy: How Innovation Sustains Prosperity in a More Connected World. Princeton, NJ: Princeton University Press, 2008.

Some Heavily Subsidized Hospitals File Liens Against Poor Patients, Rather Than Bill Medicaid

Laws that were once well-intentioned but are now outdated often remain on the books. The laws that allow hospitals to take out liens on the property of poor patients are an example. Some policy experts have proposed that each law or regulation should have a “sunset clause” that gives a date on which they expire unless they are passed again. Another solution to the lien practice would be if all hospitals were managed on the basis of ethical side-constraints. They would then not take advantage of the perverse incentives that the lien laws create.

Even without ethical side-constraints, exploiting the outdated lien laws would be harder if greater competition between hospitals created greater transparency about shady practices–the reputation of unethical hospitals would suffer, and they would lose patients.

(p. A1) When Monica Smith was badly hurt in a car accident, she assumed Medicaid would cover the medical bills. Ms. Smith, 45, made sure to show her insurance card after an ambulance took her to Parkview Regional Medical Center in Fort Wayne, Ind. She spent three days in the hospital and weeks in a neck brace.

But the hospital never sent her bills to Medicaid, which would have paid for the care in full, and the hospital refused requests to do so. Instead, it pursued an amount five times higher from Ms. Smith directly by placing a lien on her accident settlement.

Parkview is among scores of wealthy hospitals that have quietly used century-old hospital lien laws to increase revenue, often at the expense of low-income people like Ms. Smith. By using liens — a claim on an asset, such as a home or a settlement payment, to make sure someone repays a debt — hospitals can collect on money that otherwise would have gone to the patient to compensate for pain and suffering.

They can also ignore the steep discounts they are contractually required to offer to health insurers, and instead pursue their full charges.

The difference between the two prices can be staggering. In Ms. Smith’s case, the bills that Medicaid would have paid, $2,500, ballooned to $12,856 when the hospital pursued a lien.

“It’s astounding to think Medicaid patients would be charged the full-billed price,” said Christopher Whaley, a health economist at the (p. A19) RAND Corporation who studies hospital pricing. “It’s absolutely unbelievable.”

The practice of bypassing insurers to pursue full charges from accident victims’ settlements has become routine in major health systems across the country, court records and interviews show. It is most lucrative when used against low-income patients with Medicaid, which tends to pay lower reimbursement rates than private health plans.

. . .

Hospitals have come under scrutiny in recent years for increasingly turning to the courts to recover patients’ unpaid bills, even in the midst of the coronavirus pandemic. Hospitals, many of which received significant bailouts last year, have used these court rulings to garnish patients’ wages and take their homes.

But less attention has been paid to hospital lien laws, which many states passed in the early 20th century, when fewer than 10 percent of Americans had health coverage. The laws were meant to protect hospitals from the burden of caring for uninsured patients, and to give them an incentive to treat those who could not pay upfront.

. . .

When states have permissive hospital lien laws, some hospitals take advantage in ways that hurt patients. These hospitals tend to be wealthier, The New York Times found, and many of those that received hundreds of millions of dollars in federal bailout funding during the pandemic are among the most aggressive in pursuing payment through hospital liens.

Community Health Systems, which owns 86 hospitals across the country, received about a quarter-billion in federal funds during the pandemic, according to data compiled by Good Jobs First, which researches government subsidies of companies.

One of its hospitals in Tennessee refused to bill Medicare or the veterans health insurance of Jeremy Greenbaum after a car crash aggravated an old combat wound to his ankle. Instead, the hospital filed liens in 2019 for the full price of his care, records show.

For the full commentary, see:

Sarah Kliff and Jessica Silver-Greenberg. “The Upshot; Waiting for Insurance Payout? A Hospital May Collect It First.” The New York Times (Tuesday, February 2, 2021 [sic]): A1 & A19.

(Note: ellipses added.)

(Note: the online version of the commentary was updated Feb. 12, 2021 [sic], and has the title “The Upshot; How Rich Hospitals Profit From Patients in Car Crashes.”)

Appeals of Health Insurance Claim Denials Often Succeed, but at Great Cost

About 75% of those who appeal insurer rejections of healthcare claims, end up receiving an approval of the claim. But that does not mean that of those who did not appeal, 75% would have succeeded. Presumably one difference between those who appeal and those who do not appeal, is that on average those who appeal have stronger cases. Of course there are other differences, like perseverance, and the opportunity cost of the time and energy it takes to appeal.

Those opportunity costs, and the damage to morale whether the claim is appealed or not, are usually not counted among the costs of our healthcare system.

Note also in the case discussed below that claims for treatment of rare diseases are much more likely to be denied than otherwise similar claims for common diseases. You see randomized double-blind clinical trials (RCTs) are unlikely to have been done for treatments for rare diseases for a couple of reasons. One is that it is hard to find enough patients to populate the RCT. Another is that even with an eventually successful treatment, the revenue will not be enough to cover the costs of the RCT. So insurance companies can reject the claims because there is no “evidence” for efficacy–where “evidence’ is defined as the outcome of an RCT. The lesson: if you’re going to acquire a dire illness, make sure it is a common dire illness.

(p. A1) CUMMING, Ga.—After three years of doctors’ visits and $40,000 in medical bills didn’t cure their daughter’s rare condition, April and Justin Beck found a specialist three states away who offered a promising treatment.

They set out before dawn last spring for the nine-hour drive to Arkansas Children’s Hospital in Little Rock, where Dr. Aravindhan Veerapandiyan explained how infusions of antibodies could help Emily, now 9 years old, and her misfiring immune system.

They returned home with an appointment to start the infusions. But the Becks’ insurer, UnitedHealthcare, declined to pay for a treatment it said wasn’t medically necessary.

They decided to fight back. “I really had no idea it was going to be this hard,” April Beck said.

Health insurers process more than five billion payment claims annually, federal figures show. About 850 million are denied, according to (p. A8) calculations by appeals company Claimable, based on data from health-policy nonprofit KFF and the Centers for Medicare and Medicaid Services. Less than 1% of patients appeal.

Few people realize how worthwhile those labors can be: Up to three-quarters of claim appeals are granted, studies show.

Patients who fight denied claims must marshal evidence from medical studies, navigate dense paperwork and spend hours on the phone during what is often one of the most difficult times of their lives. They debate insurers over whether a patient might ever recover from a stroke, or whether an expensive new treatment holds real promise.

. . .

The sense of futility that keeps people from appealing denied claims is part of a current of anger against insurers that surged in December [2024] after the assassination of UnitedHealthcare Chief Executive Officer Brian Thompson.

. . .

In one letter, UnitedHealthcare denied the treatment because the medication wasn’t ordered from an in-network pharmacy. In another, on July 25, [2024] the insurer said the treatment wasn’t medically necessary and hadn’t been proven helpful for Emily’s condition.

“The services are not eligible for coverage because your plan doesn’t cover unproven procedures,” the insurer said.

Rare cases often put patients and insurers in protracted conflict. Some people want experimental treatments that insurers reject because they aren’t thoroughly proven to work. But for patients with rare conditions, the number of cases are so small it’s difficult to widely document a drug’s effects.

. . .

April learned from a Facebook support group for parents of children with PANS/PANDAS about Claimable, which uses artificial intelligence to help patients appeal denials. Claimable was offering to submit claims for PANS/PANDAS patients free of charge.

The Becks on Dec. 6 [2024] sent their appeal to the new denial based on medical necessity by email to UnitedHealthcare, copying Andrew Witty, CEO of its parent company, as well as Georgia’s governor and attorney general. Claimable encouraged them to copy Witty on every interaction.

The package included a letter from the PANS Research Consortium stating that immunoglobulin therapy is widely accepted as standard treatment for kids like Emily and that, as of Nov. 22, 2024, 13 states have made it illegal to impede access to the treatment for people with PANS/PANDAS. The letter cited 25 studies backing the treatment’s efficacy. It was cosigned by physicians from Stanford and the National Institutes of Health.

. . .

Two days before Christmas, a representative from UnitedHealthcare called to say Emily had won her appeal. UnitedHealthcare told the Journal that its medical director decided the infusions would be appropriate as a trial for Emily.

For the full story see:

Julie Wernau. “These Families Beat Health Insurers.” The Wall Street Journal (Friday, February 13, 2025): A1 & A8.

(Note: ellipses, and bracketed years, added.)

(Note: the online version of the story has the date Feb. 12, 2025, and has the title “Health Insurers Deny 850 Million Claims a Year. The Few Who Appeal Often Win.”)

“Once Autonomous and Highly Esteemed, Doctors” Lament Being “Trapped Between Insurers” and Hospital Managers

As health regulations and malpractice lawsuits increase, doctors have increasingly needed support staff to help them navigate the morass. Large hospitals and clinics have such support on staff, so doctors increasingly have found it easier to join such institutions, than to run their own private practice. But a trade-off is that they give up considerable autonomy, making the practice of medicine less fulfilling and risking burn-out. To protect themselves and their institutions, doctors must follow the protocols rather than follow their experience-based judgement to innovate for the benefit their patients.

(p. A6) The killing of a top health insurance executive outside a Midtown Manhattan hotel last week triggered an outpouring of public anger at an industry many Americans blame for the ills of the nation’s healthcare system.

Count doctors among the aggrieved.

. . .  Doctors say their frustration is born of intimate experience and has been building for years.

Their chief complaint is the aggravation and expense of convincing insurance companies to pay them for their patients’ treatment. Even when they are ultimately approved, MRI scans and other vital but costly procedures often require days of campaigning and paperwork, say doctors.

“It’s getting worse,” said Dr. Zulfiqar Ahmed, an internist in Augusta, Ga., who has practiced in the U.S. for 35 years. “This is not only UnitedHealthcare—this is universal in this country.”

. . .

“They hire certain doctors, and they sit at a desk, and their whole purpose is to deny or delay,” Ahmed said, echoing a common complaint among doctors.

. . .

In a recent post on X, Dr. Alan Nguyen, a spine specialist in Fort Myers, Fla., noted that when insurance-company doctors reject an MRI request, he now asks for their name and health provider identification number. “I tell them if a cancer is missed, then the patient will know who to sue,” wrote Nguyen. In an interview, he said he believes the situation had worsened significantly over the last five years. When insurers denied treatment, Nguyen observed, doctors were still left to deal with the patients and their pain.

A familiar lament among doctors is how sweeping changes over the last 20 years—some instigated by insurers, others not—have degraded their profession. Once autonomous and highly esteemed, doctors are increasingly employees of large hospital chains and find themselves trapped between insurers and their own cost-conscious management.

. . .

Dr. Richard Lechner, a family dentist in New Britain, Conn., for years paid for three administrative staff members whose days, he said, were mostly spent fighting with insurers. This for an office that consisted of one dentist and two hygienists.

“They’re always throwing up roadblocks for practitioners like me to get paid,” Lechner said. Requests for additional documentation, or claims of paperwork lapses, were, he said, “specifically designed to prolong, prolong, prolong and then hope the dentist gives up.”

Last year, Lechner did give up: He sold his private practice to Dental Associates of Connecticut, a company that operates a network of more than 40 dental offices across the state. Like Davidian, he is now an employee. Much of the work of chasing insurance claims is now handled by a specialist team at Dental Associates’ central office.

“The primary reason I sold my dental practice is because I couldn’t keep up with the insurance companies’ shenanigans,” he said. “I thought I was going to have a stroke.”

For the full story see:

Joshua Chaffin and Julie Wernau. “Haggling With Insurers Getting Worse, Doctors Say.” The Wall Street Journal (Friday, Dec. 13, 2024): A6.

(Note: ellipses added.)

(Note: the online version of the story has the date December 12, 2024, and has the title “Doctors Say Dealing With Health Insurers Is Only Getting Worse.” Where the online version provides somewhat more elaboration than the print version, the passages quoted above follow the online version. In the print version, but not the online version, the last four paragraphs quoted above appear in a separate boxed sidebar with the title “Dentist Gave Up, Sold His Practice After ‘Shenanigans’.” In the online version, the paragraphs appear at the very end of the main article, with no separate heading or sub-heading.)

“The Pitt” Captures ER Reality, but Omits the Burden of Paperwork

I have not seen “The Pitt,” but I enjoyed the intensity and the theme song of “ER.” I also am a fan of the creator of “ER,” Michael Crichton, who shortly before cancer stole his life, had the courage to stand up against dishonest environmentalism.

(p. A10) “The Pitt” is a rare type of hospital drama—one that gets it right, according to real-life medical workers.

. . .

From their perspective, “The Pitt” is the most authentic medical drama since “ER.”

. . .

In August [2024], the estate of “ER” creator Michael Crichton sued the studio, Warner Bros. Television, and several producers behind both shows. The lawsuit alleges they developed “The Pitt” as a sequel to “ER” and changed only a handful of plot details after negotiations with the estate faltered. Warner Bros. Television declined to comment.

. . .

Dr. Weston McCarron, a fan of the series, wants his wife to watch so she can “finally start to get a glimmer of a feeling for what I do at work.” He supervises overnight shifts at a St. Louis trauma center, where he treats everything from gunshot wounds to farm-equipment injuries in patients flown in from rural areas.

“You go from these outrageously stressful and heart-wrenching situations to the opposite, within minutes,” McCarron said. “The Pitt” nails the seething atmosphere of a crowded waiting room, and the moment a grieving mother’s wails ring through the ward, he said. But the doctor quibbled with some things, such as the show glossing over how much time doctors spend on computers filling out patient charts.

For the full review see:

John Jurgensen. “‘The Pitt’ Is a Hit With Medical Workers.” The Wall Street Journal (Wednesday, Feb. 19, 2025): A10.

(Note: ellipses, and bracketed year, added.)

(Note: the online version of the review has the date February 13, 2025, and has the title “Doctors Agree: Finally, a Medical Drama That Gets It Right.”)

Curing Cellular Senescence Could Extend Healthy Lifespan

Senolytics are chemicals that kill senescent cells, cells that do function properly but do not die. The cells are believed to cause aging and eventual death. They also are believed to cause illnesses such as coronary artery disease and Alzheimer’s. If senescent cells can be expelled, then we can hope to extend, not just lifespan, but what really matters–healthy lifespan.

(p. A10) The same underlying factors that contribute to aging also play a role in the development of diseases, says Richard Faragher, a professor of biogerontology at the University of Brighton and board member of the American Federation for Aging Research. He cites the example of a biological process called cellular senescence, which is when cells that stop dividing but don’t die build up as people age. The process is linked to various age-related diseases.

“Can we do anything to impact the fundamental biology of human aging? I think the answer is an emphatic yes,” says Faragher.

Longevity drugs, if proven to work, could slow or prevent the onset of age-related conditions rather than treating them after they develop, and eventually save millions on chronic disease spending in later life, advocates say. In 2021, the costliest 1% of traditional Medicare beneficiaries accounted for 19% of spending, according to the nonpartisan watchdog agency the Medicare Payment Advisory Commission. Beneficiaries in their last year of life tend to generate more spending than others.

For the full story see:

Alex Janin. “The Scientific Fight Over Whether Aging Is a Disease.” The Wall Street Journal (Wednesday, Feb. 5, 2025): A10.

(Note: the online version of the story has the date January 27, 2025, and has the same title as the print version.)

Warren Buffett Said Obamacare Is “Two Thousand Pages of Nonsense”

Our health system is a mess. The latest major effort to “fix” it was Obamacare (the so-called “Affordable Health Act”)–two thousand pages cobbled together by lobbyists, deep state staffers, and legislative log-rolling that resulted in high costs, opaque rules, perverse incentives, and unintended consequences.

(p. A15) Medicare doles out reimbursements for services that may or may not be real, helpful to the recipient, or reasonably priced. It’s very hard to know. Congress doesn’t want doctors and hospitals back home closely policed. Result: Medicare controls spending, perversely, with blanket low reimbursement rates for necessary and unnecessary services alike.

. . .

. . . government programs are born in chaos—with congressional horse trading and payoffs to appease interest groups. That’s why government programs make so little organizational sense. Remember when we had to pass Obamacare to find out what was in it? (“Two thousand pages of nonsense,” said Warren Buffett at the time. “The problem is incentives.”)

For the full commentary see:

Holman W. Jenkins, Jr. “Business World; Elon Musk’s Useful Experiment.” The Wall Street Journal (Wednesday, Feb. 12, 2025): A15.

(Note: ellipses added.)

(Note: the online version of the commentary has the date February 11, 2025, and has the title “Business World; DOGE Is Elon Musk’s Useful Experiment.” In both the online and print versions, the phrase “born in chaos” appears in italics for emphasis.)

“Stand for Health Freedom”

I believe that respecting each other’s freedom is what makes America exceptional. It is the right thing to do. But what a wonderful miracle, that on balance respecting freedom results in much else that is good, including better health and more happiness.

I believe that vaccines sometimes have bad side effects, but that on balance some vaccines are among the greatest contributions to human health.

But we should convince, not mandate. We should respect freedom because that is what is moral to do. And if we do, there will be more medical innovation; more and faster cures.

(p. A11) Ms. Wilson’s organization, Stand for Health Freedom, has become part of a grassroots push . . . .  . . .  To Ms. Wilson, those involved have coalesced around one idea: “There’s roles for government, and telling us how to care for our bodies is not one of them.”

. . .

Stand for Health Freedom is a young organization, but the wider movement “goes to the very roots of America,” said Lewis A. Grossman, a professor at American University’s law school who has studied the history of libertarianism.

“There’s always been a robust portion of Americans who embrace these values,” Mr. Grossman said. As early as 1902, organizations like the American Medical Liberty League were pushing for freedom from vaccine mandates. In the 1950s, the John Birch Society and National Health Federation took up the cause. In 1975, a group opposed to water fluoridation in Rockland County, N.Y., called itself the Citizens for Health Freedom.

But by and large, these groups and others like them existed outside the mainstream. Starting in the 1960s, however, American trust in institutions began to wane.

. . .

Then, Covid struck and cities were locked down. Public health officials also fumbled critical early messaging, painting the vaccines as a “miracle” that would provide permanent immunity, said Michael T. Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

“We really lost credibility, because that’s not what happened,” Dr. Osterholm said.

Suddenly, medical freedom became a salient issue to many more Americans, and resistance to Covid restrictions became their unifying principle.  . . .

Much of that growth occurred online, as people lost faith in traditional medical institutions and searched for like-minded thinkers, Dr. Osterholm said. New supporters flocked to Ms. Wilson’s organization as it took on all sorts of causes.

. . .

As it grew, Ms Wilson’s organization gained support from a politically diverse group of advocates. Roughly 40 percent of the people who have taken action on the platform are Democrats, she claimed. Ms. Wilson saw this as evidence that “there are plenty of people who care about being the one who makes the ultimate health decisions for their children,” she said.

“This is common sense,” she added, “not strange or rare.”

For the full story see:

Kate Morgan. “Vaccine Protesters Find Winning Slogan: ‘Health Freedom’.” The New York Times (Wednesday, January 1, 2025): A11.

(Note: ellipses added.)

(Note: the online version of the story was updated Dec. 31, 2024, and has the title “How ‘Health Freedom’ Became a Winning Rallying Cry.”)

Obamacare (the So-Called “Affordable Care Act”) Has “A Complex, Often Byzantine, Eligibility and Enrollment System”

Obamacare, Medicare, and Medicaid are supposed to help the least-well-off. But the least-well-off are exactly those who are least able to navigate the red-tape of the bureaucracy. Signing up for Amazon Prime was far simpler than signing up for Medicare. (My source is personal experience.)

(p. A18) The Trump administration on Friday said that it would drastically cut annual spending on so-called navigator groups that help Americans enroll in Obamacare health insurance plans, from around $100 million to just $10 million.

. . .

The Trump administration on Friday [Feb. 14, 2025] noted that health insurance navigators enrolled only 92,000 people on the Affordable Care Act’s marketplaces last year, or less than 1 percent of plan participants, amounting to more than $1,000 per enrollment. During Mr. Trump’s first term, with funding levels similar to the one announced Friday, navigators enrolled people at “a far more efficient $211 per enrollment,” the Centers for Medicare and Medicaid Services said in its announcement.

. . .

“They are primarily there to help people navigate a complex, often byzantine, eligibility and enrollment system,” said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms.

For the full story see:

Noah Weiland. “Administration Will Cut Funds For Navigators Of Obamacare.” The New York Times (Saturday, February 15, 2025): A18.

(Note: ellipses, and bracketed date, added.)

(Note: the online version of the story has the date Feb. 14, 2025, and has the title “Trump Shrinks Funds for Navigators Who Help Americans Enroll in Obamacare.”)