We don’t want government telling us what to put in our mouths any more than we want them to tell us what can come out of our mouths. And the federal government has no legal authority to prevent state governments from changing their laws to remove state-level penalties for medical marijuana use. As a conservative state with a love for individual liberty and for federalism, this should be an easy decision, especially if we take the time to review the facts. In my view, the evidence is overwhelming.
Polling demonstrates that citizens are ahead of politicians and legislators across the county on this issue, with anywhere from as low as 65 percent to as high as 94 percent of Americans supporting the legalization of medical marijuana. And it spans all ages and party affiliations. A vast majority of Americans recognize the legitimate medical benefits of marijuana, as well as a large number of medical organizations. It is less harmful and poses fewer negative side effects than most prescription drugs – especially opiate-based painkillers – and patients often find it to be a more effective treatment.
Licensed medical doctors, already heavily regulated by the state, should be allowed to recommend solutions to deal with debilitating medical conditions, no matter the derivative of such solutions. If marijuana can provide relief to those suffering from terrible illnesses like cancer and HIV/AIDS, it is unconscionable to criminalize patients for using it. People who would benefit from medical marijuana should have right to use it legally. Legal prohibitions on commonly accepted behavior has never produced positive results. It’s bad public policy.
Medical marijuana is not the same as recreational marijuana and to try to conflate the two is an insult to the citizens of Mississippi and comes at the expense of patients who should be free to choose a legal option to opiate-based painkillers, with the guidance of their doctor. Rather than trying to turn this issue into a “law and order” one and attempting to convince us that patients suffering from debilitating illnesses and the doctors caring for them are criminals, our politicians should focus on removing this unnecessary barrier. The federal government put the barrier in place and 31 other states have rightly removed it. There is no legitimate reason for Mississippi not to do the same.
This is not a “crackpot” or “fringe” issue. The American Medical Association, The Institute of Medicine, and the American College of Physicians have all acknowledged the potential benefits of medical marijuana and the New England Journal of Medicine reported 76 percent of surveyed physicians would recommend it to a patient. Other legitimate health organizations supporting it include; American Academy of Family Physicians, American Nurses Association, American Public Health Association, American Academy of HIV Medicine, and the Epilepsy Foundation.
Government is already regulating the healthcare industry at an unprecedented level. The federal government has grown into an unwieldy and unresponsive beast – increasing its paternalism over us all. Is all of this really required? Is it even legitimate? Mississippi can join the other states who value federalism and respect the rights of patients and licensed doctors to decide what is best.
For liberty-minded conservatives, this should be an easy decision.
This column appeared in the Clarion Ledger on August 6, 2018.
The Trump administration has expanded options for families struggling to find affordable health coverage.
The departments of Health and Human Services, Labor and the Treasury issued a new rule allowing individuals or families to utilize short-term, limited duration plans of up to 12 months, with potential for extensions up to 36 months. The Obama administration restricted these plans to three months without the option for renewal in 2016.
Short-term, limited-duration insurance is not required to comply with federal market requirements. It is largely used for those who are transitioning between different coverage options, such as those who would otherwise have a lapse in coverage when starting or transitioning to a new job, but can also be used by families without access to subsidized Obamacare plans because they make a little too much to qualify for a subsidy.
But they can’t afford the cost of health insurance.
These plans will be significantly more affordable. In the fourth quarter of 2016, the average monthly premium for an individual with a short-term plan was $124, compared to $393 for an unsubsidized plan in the exchange.
A recent report found that the number of people enrolling in the individual markets without subsidies declined by 20 percent, while premiums rose by 21 percent.
The Affordable Care Act is not working for too many Americans and it is becoming too expensive. This is a step to finding alternative healthcare coverage options for middle class citizens who are caught in the gap between not having employer-provided benefits and not qualifying for ACA subsidies.
Any steps towards a more market-based approach where we start to introduce competition, choice, and price rationale to the healthcare system is welcomed.
Over the past month The Clarion-Ledger has highlighted aspects of Medicaid that make the program feel indispensable, with Sam Hall proclaiming that anyone who questions Medicaid’s “valuable services to deserving people” is just plain ignorant. As someone who cares about improving health care for the poor and disabled, however, I find Medicaid’s poor health outcomes shocking. With flexibility from Washington and a focus on quality, states like Mississippi could provide better care for families in need.
It’s difficult to argue with heart-wrenching stories about how Medicaid is helping Mississippi families. For the price — $8 trillion over the next 10 years — one would hope advocates could find a few good stories. Not every Medicaid story has a happy ending, though. A University of Virginia study found that Medicaid patients are more likely to die than the uninsured, and far more likely to die than those with private insurance.
Another story we are not hearing is what the “gold-standard” Oregon Health Insurance Experiment found: that Medicaid recipients, compared to the uninsured, use a lot more health care services without experiencing improved physical health outcomes. The Oregon study also demonstrated that the primary beneficiaries of Medicaid are not patients but hospitals.
The worst thing about Medicaid is that it is crowding out innovative solutions that could deliver better care — not just more services. Breaking up this big-government Medicaid monopoly is going to require hard work from all of us. Here are three questions to start the conversation.
First: Does Medicaid provide good insurance for low-income families?
As many as 50 percent of primary care physicians in Mississippi are not accepting new Medicaid patients, as compared to 7 percent not accepting new patients with private insurance. As mentioned, Medicaid patients also have, at best, the same health outcomes as the uninsured. Clearly, Medicaid is inferior insurance. State and federal policymakers should facilitate the development of better insurance products tailored to low-income customers.
Second: Is Medicaid a cost-effective way of reimbursing hospitals for uncompensated care?
In spite of studies (and common sense) showing otherwise, hospitals claim they are losing money on Medicaid. Under federal law, hospital emergency rooms are prohibited from turning patients away. Medicaid is a pricey backdoor mechanism for funding this mandate. Tax credits might be part of the solution for private hospitals. In addition, nonprofit and public hospitals should offer more charity care — certainly far more than the tiny amount provided now under vague “community benefit” provisions.
Third: Is Medicaid the best way to help families facing extraordinary medical costs?
Prior to Obamacare, Mississippi had developed a high-risk insurance pool to help people with significant health care challenges. We need more creative thinking about risk pools (for instance, an income tax credit for donations to nonprofit-managed risk pools); and we need to focus on supply-side deregulation (encouraging telemed, expanding scope, and eliminating certificates of need) that will lower costs and unleash new medical technologies. These reforms are better than depending on a Medicaid program that will be sorely tempted to ration care to high-need populations even as it expands coverage to able-bodied childless adults, for which the Obamacare Medicaid expansion curiously offers a higher federal match.
Finally, I appreciate The Clarion-Ledger trying to inform readers about Medicaid, but I urge a good dose of old-journalism-school skepticism. When the director of Medicaid boasts that there is virtually no eligibility fraud, perhaps it would be helpful to note that other states are uncovering significant irregularities. Or when a Medicaid activist asserts that Congress’ repeal-and-replace bill is going to remove thousands of children from Medicaid, it would be appropriate to fact-check this number, or at least note that these children are going to go back on CHIP, a different insurance program run by the Division of Medicaid.
I am confident we can all agree on the necessity for fresh thinking about health care. Instead of just thinking about it, though, I hope Congress gives states freedom to demonstrate how they can either radically improve upon Medicaid, or even better, develop targeted solutions aimed at helping the diverse populations Medicaid is currently failing.
Jameson Taylor is vice president for policy at the Mississippi Center for Public Policy in Jackson. He can be reached at [email protected].
Telemedicine: High-Quality, Affordable Care for Mississippi Families
Hearing on Telemedicine
Testimony before the Miss. State Senate, Public Health & Welfare Committee
October 18, 2016
(Unabridged version)
I am Dr. Jameson Taylor, vice president for policy with the Mississippi Center for Public Policy.
This is what we believe about telemedicine: Telemed needs to be allowed to flourish and grow and respond to consumer needs. Burdensome regulations will hinder this growth and reduce access to high-quality care. To repeat: We believe telemedicine needs to be allowed to flourish and grow and respond to consumer needs. Burdensome regulations will hinder this growth and reduce access to high-quality care.
You might say we believe in a free market for healthcare. What this really means is that we believe that a light regulatory touch will promote the supply side of healthcare and solve the problem of access by increasing quality and lowering cost. In other words, if government stays out of the way, healthcare innovation will massively increase the supply of affordable, high-quality care. This strategy has worked for computers and cell phones. Why not healthcare?
But I am here today, not as a healthcare policy analyst, but to share my own telemed story with you.
I am married and have two children. Over the past few years, our family has paired telemed with a High Deductible Health Plan. Our family deductible is typically $5,000 a year. What this means is that my insurance company does not cover a dime of my healthcare until I spend $5,000 out of pocket. In this respect, my family is not different from many others in Mississippi. For instance, if we look at the health insurance policies on the ACA exchange, we see deductibles ranging from $4,000 to $13,000.
Just yesterday, I pulled up a plan for a family of four in Hinds County. One option was a bronze plan from Magnolia Health at a cost of $800 a month and a deductible of $13,600 a year.
I guarantee that if you have a deductible of $13,000 a year, you are going to act like an informed consumer for healthcare because you are going to be paying cash, almost exclusively, for your care. That, at least is how my family and I shop for healthcare. We approach healthcare as consumers and believe that a free market for healthcare is the best way to attain high-quality care at a fair price.
When we consider taking our kids to the doctor for the usual problems: sniffles, an ear infection, a stomach ache, we have a choice between using telemed at $40 a visit or going to our pediatric specialist for $165 or going to MEA for around $120. Depending on the situation, we choose the option we think is best for our family. Sometimes it is telemed, sometimes it is an in-office visit, sometimes it is MEA.
Let me walk you through a typical telemed visit for us. Our usual provider, by the way, is connected with Blue Cross Blue Shield and is called Doctor on Demand.
Last year, our daughter had the typical crud that turned into a fever. We had a family event coming up, and my wife wanted to make sure we did all we could to get our daughter feeling better. That said, it wasn't a very serious illness. At $40 a visit, we chose to use telemed. The alternative would have been an in-office visit at $165. Under those circumstances, we would not have gone to the doctor.
I want to make this point very clear: This is not an apples to apples scenario. If you hinder access to telemed, you are not necessarily generating new business for brick-and-mortar doctors. You are, for some people - the single mom with no cash to spare, a family on vacation down in Biloxi, a truck driver on the road -eliminating that doctor's visit altogether.
Money and time are not infinite resources - at least not in my world and not for the hardworking people of Mississippi. If we did not have the option of using telemed in this case, we would not have gone to the doctor at all. We would have waited things out and hoped our daughter recovered.
Again, our situation is not unusual. We all know access to healthcare is a problem in Mississippi. One-third of our population is underserved because we do not have enough primary care physicians and rural doctors.
This problem will not be resolved by giving everyone an insurance card - whether it be private insurance or government-sponsored insurance, like Medicaid.
According to a recent study by researchers at the Social Science Research Center at Miss. State:
- "32% of adults covered by private insurance (ages 50-64) reported difficulties in obtaining an appointment when seeking an initial appointment with a primary care physician";
- "35% of Medicare-insured adults (ages 65 and older) reported problems when seeking a new appointment"; and
- "Up to half of primary care physicians' offices in Mississippi are not accepting new Medicaid patients."
All of these people have insurance, but they are having trouble obtaining primary care.
I believe we are making a fatal mistake in approaching healthcare in Mississippi from an attitude of scarcity and protectionism. We have an abundance of healthcare needs. We have so much need we can't handle it all. Why regulate a telemed market that is clearly working to address some of these needs?
The study from Mississippi State also notes the following:
"Even with health insurance, access to care may be limited by several factors, including whether one can contact doctors' offices by telephone during office hours, whether one can receive a scheduled appointment within a reasonable amount of time, lengthy waits in doctors' waiting rooms, restrictive clinic hours, and patient access to transportation."
Telemed can help with all of these access problems.
In our case, we usually use telemed early in the morning or late at night, when we are trying to figure out just how sick we are and whether we need to take a sick day from school or work.
Likewise, the wait for a telemed appointment is usually 10 minutes or less. In our case, we are able to pull up a screen full of doctors - all of them licensed in Mississippi - and choose the doctor we want. Usually, we choose the same doctor. Her primary practice is in California.
As far as waiting rooms go, I also want to add that, frankly, as a parent, the last thing you want to do is expose your child and yourself to other sick patients in the waiting room. The last time my wife took our kids in for a routine checkup, our doctor informed her that she was seeing a lot of children with hand-foot-and-mouth disease. That is not a comforting thought when you are in a crowded waiting room trying to keep your toddler from chewing on and handling everything he can reach.
Indeed, in my research on this issue, I found several medical sources that suggested simply avoiding the waiting room altogether. Advises Dr. Hansa Bhargava, medical editor for WebMD:
"As a doctor, here are some guidelines I use for myself:
"Stay home if you can. Ask yourself: are you sick enough to need to go in? Granted, this can be a hard decision. ...
"If you are not sure whether you need to come in, try calling your doctor's office. This way, you may be able to save yourself a visit."
Telemed delivers the best of both worlds. It allows you to stay home and see your doctor. My family and I value the convenience and, if you will, additional safety, telemedicine provides. For me, a quick telemed visit may mean the difference between missing a morning of work or not. For my kids, it means the same when it comes to school. For my wife, it means access to high-quality care at the touch of a button. Imagine that, at the touch of a button. ... But isn't that the kind of service we expect today?
You can order all manner of life-saving products online - for instance, that last-minute wedding anniversary gift ... at the touch of a button.
You can book a dream vacation - instead of going to a travel agent - at the touch of a button.
You can sit in on courses at MIT and radically change the direction of your entire life - at the touch of a button.
Why is healthcare so radically different that we are going to deny consumers this same choice?
To get back to our routine telemed visit, during the last three visits, we have been offered a prescription twice. In my limited research, this is on par with the national average for in-office visits.
And, let me be honest, if you are going to pay $165 for a doctor's visit, you kind of expect to walk out of the office with some kind of vindication that you were right to go to the doctor - a prescription. Many patients want that antibiotic, even if it's just for a bad cold. When you pay $40 for a visit and you hear that all you really need is some sleep and orange juice, you feel a lot better about the hit to your pocketbook.
Before I end, one thing I want to mention is that we prefer to connect with our telemed doctor over the phone, as opposed to video feed. I live in Jackson. I have a decent internet connection. Many Mississippians do not. Just like any technology, you want multiple options: both phone only and video.
I suspect, too, that my wife prefers the phone consult because, then, she doesn't feel like she has to do her hair and make the kids picture perfect before seeing our doctor.
In any event, the phone consult has worked well for us. Indeed, I imagine nearly every person here has been on one end or another of a phone-only consult with their brick-and-mortar doctor.
Of course, most doctors doing telemed ARE brick-and-mortar doctors. As I mentioned, they are also licensed by the state of Mississippi.
And that is, really, what all this comes down to. If the state is going to license doctors, it needs to trust these doctors to serve their patients in whatever setting they choose.
Whether it's in a telemed setting or an office setting, we have to trust the doctors to make the best decisions for their patients. Otherwise, the state shouldn't license doctors to begin with. We also have to trust families like mine to make the best healthcare decisions we can for our children. ... Because I guarantee that I care a lot more about my kid's safety and health and my own health than any other person in this room.
Finally, I want to end with a quick story about Billy Durant. Durant co-founded General Motors. But before he founded GM, he worked for a carriage maker. As a carriage maker, he vehemently spoke out about how dangerous automobiles were. He called the new technology "smelly, noisy, and dangerous." He even refused to let his daughter ride in a car. Less than four years later, Durant co-founded GM.
Like the automobile revolution during Durant's day, the healthcare revolution has already begun. We can use our smartphones to monitor blood sugar levels and measure heart rates. Patients increasingly want to text and web chat their doctors. Soon, we are going to see nanotechnologies that can be implanted in patients, perhaps making routine doctor visits a thing of the past. Government cannot regulate all of these innovations. And Mississippi shouldn't let bureaucracy be the reason we don't share in this progress. Take a cue from Billy Durant and join the winning side - the side that promises to expand the supply of high-quality, low-cost care for the people of Mississippi.
Thank you.
Most rational people are concerned about the unconscionable burden of debt being placed on our children and grandchildren by the federal government. The explosion in federal spending is largely due to the rapid and unsustainable growth in entitlement programs. (more…)
Fact 1: Medicaid harms patients by providing low-quality care
The goal of Medicaid should be to provide high-quality health care at an affordable price. Medicaid fails to do that.
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As part of the president's health care plan ("ObamaCare") states are being encouraged to expand Medicaid to cover able-bodied adults who earn up to 138 percent of the federal poverty level (FPL). Medicaid already covers low-income mothers and children, as well as disabled adults and low-income seniors. Expanding Medicaid will cover adults with no children who are working or could be working -- at least some of whom already have private insurance coverage. In addition to being unnecessary, the expansion will result in lower quality care for Medicaid patients, higher taxes and debt, and job losses for the country as a whole.
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We appreciate Governor Bryant's willingness to take a stand on this issue. The promise of state control over an Obamacare health insurance exchange is an illusion. Federal officials have the power to dictate the operation of an Obamacare exchange, and we have no doubt they will do so over time.
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Contrary to what was reported in this newspaper on Sunday, I did not "help design the [state health insurance] exchange used today," and I have consistently opposed the creation of an exchange under the Affordable Care Act (ACA). A brief call to my office before publishing these inaccuracies - and others - would have been helpful. (more…)