Third Quarter Report 2019

Oct 1, 2019

2019 Third Quarter in Review

During the third quarter, the Goodman Institute joined with the Heritage Foundation to develop a health reform plan for the Trump administration, developed a solution for surprise medical bills, explained what Republicans and Democrats want to do with Medicare and created a new environmental blog.
During the third quarter, the Goodman Institute joined with the Heritage Foundation to develop a health reform plan for the Trump administration, developed a solution for surprise medical bills, explained what Republicans and Democrats want to do with Medicare and created a new environmental blog. Think Tanks Unite Behind a Health Plan – Finally! The plan was prepared for the Trump administration by John C. Goodman (father of Health Savings Accounts) and Marie Fishpaw (Heritage Foundation) and published by National Review Online.  It features such patient-friendly ideas as portable health insurance and doctor consultations by means of phone, email and Skype.


The plan, which relies heavily on changes the Trump administration has already been implementing, would make it easier for patients to have an inexpensive concierge relationship with their doctors – getting access to care at nights and on weekends without going to hospital emergency rooms. “We have cut the Gordian Knot that has held back conservative health reform for three decades,” says Goodman. “Most people in hospital emergency rooms don’t need to be there,” he says.  “They can be examined in the comfort of their own homes using a cell phone with an app or two.” The plans stress the idea of empowering patients – by giving them the same opportunities they have in other markets. “Medicine needs to step into the 21st century,” says Goodman. Five Reform Ideas Health reform should make it easy as possible for people to access innovations such as:
  1. Personal and portable health insurance that travels with people from job to job and in and out of the labor market.
  2. Round-the-clock access to physicians by phone, email, and Skype.
  3. Telemedical “doctor visits” from home – avoiding traffic, long waits, and trips to emergency rooms.
  4. Centers of excellence specializing in chronic health conditions and actively competing for patients.
  5. Accounts owned and controlled by patients who are willing to manage their own care, including most forms of chronic care and even routine surgery.

Surprise Medical Bills


More than 4 in 10 patients who visit an emergency room or enter a hospital are confronted with bills for out-of-network services – even though the insurance company and the hospital led the patients to believe their care would be in-network. In some cases, patients have faced charges that are many thousands of dollars. Three solutions to this problem have been proposed: Goodman Institute solution: Insurers and hospitals should not be able to claim the hospital is in the insurer’s network if that isn’t 100% true. Otherwise, it’s false and misleading advertising. Under such a rule, hospitals and insurance companies would negotiate solutions that no longer surprise unsuspecting patients. Sen. Bill Cassidy’s solution: Hold the patient harmless and let the hospital and the insurer negotiate a reasonable fee. Failing that, let them go to arbitration.  Senate Labor Committee solution: Price controls that (according to the CBO) would transfer 20 cents of every dollar out of the pockets of doctors and hospitals and into the pockets of insurance companies. Writing at Forbes, John Goodman said this approach would not encourage insurers and providers to negotiate fee arrangements in advance. It would do just the opposite. By refusing to negotiate with emergency room physicians, for example, insurers could be assured of having to pay no more than the median in-network fee.


How the Trump Administration Is Reforming Medicare The Trump administration is making fundamental changes to the Medicare program. The administration is following the approach first proposed by John Goodman in Regulation of Medical Care: Is the Price Too High? (Cato: 1980)  and expanded in his book with Gerald Musgrave, Patient Power: Solving America’s Health Care Crisis (Cato: 1992), and more recently in Priceless: Curing the Health Care Crisis (Independent Institute: 2012). The Trump policy toward health care is based on the idea of promoting choice, competition and market prices. In Medicare so far, that means liberating telemedicine, liberating Accountable Care Organizations, ending payment incentives that are driving doctors to become hospital employees, promoting hospital price transparency, deregulating paperwork and creating more transparency in the market for prescription drugs. Larry Wedekind and John Goodman described these changes in a post at the  Health Affairs Blog and two follow-up pieces in Forbes.
We Have a New Environmental Blog    The Liberty, Ecology and Prosperity blog is about appreciating and protecting the environment using the tools of economics. The blog manager is Jane Shaw Stroup, a former senior fellow of the Property and Environment Research Center (PERC). John Baden, father of the New Resource Economics, is the lead-off blogger. (See the side bar.)



What you will learn from recent posts:
  • On extreme weather: Hard data, collected over decades, show no increase in the frequency or severity of hurricanes over the past century. Also, droughts are not more common, severe, or of greater length.
  • On Amazon fires: They are mostly on farms and ranches; there is no increase in forests burning; the number of fires in 2019 is only 7% higher than the average for the past 10 years; and news coverage has been inundated with fake photos.
  • On the international threat to food production: Global crop production has been setting new records virtually every year.
  • On the threat of one million species extinctions: Over 500 years there have been 800 known extinctions; the number peaked in the nineteenth century and has been declining since.
  • On Greenland ice melting: After a very brief period (a few days) of strong melt, conditions have returned to normal.
  • Are global warming skeptics dying off? (Yes.)
The New Resource Economics John Baden is an intellectual entrepreneur. Together with his colleagues in Bozeman, Montana, he pioneered a new approach to environmental policy. It harmonizes three values: ecology, prosperity, and liberty. The conventional approach is to assume that government ownership and government regulations are necessary correctives to perceived “market failures.” The new approach recognizes that “government failures” are a curse that can be just as bad and sometimes worse. (For example, government-subsidized dams can divert ecologically valuable water to subsidized crops.) Under the banner of the New Resource Economics, scholars have shown that important environmental goals are more reliably achieved when government’s role is made smaller and when property rights, freedom of contract and entrepreneurship take center stage. From Goodman Institute Brief Analysis 119.
  What Would Medicare for All Mean? Bernie Sanders, dozens of other Democratic candidates running for office this year, and almost everybody on the political left, think that Medicare is government insurance and that it is completely different from private insurance. This conception turns out to be wrong. One-third of all seniors are enrolled in insurance plans offered by Humana, Cigna, UnitedHealth care and other private insurers under the Medicare Advantage program.  This is one of ten surprising facts readers can discover in a new Brief Analysis by John Goodman. Briefing on Capitol Hill Although President Trump often promises he will produce a health plan in the future, his administration has already instituted fairly radical reforms that have received very little attention in the mainstream media and even in the health care media. In September, John Goodman conducted a Capitol Hill briefing on what Trump has already achieved and what Congress needs to do to complete the reform. He was joined by Brian Blaise, formerly special assistant to the president for health policy; Grace-Marie Turner, president of the Galen Institute and leader of the Consensus Group; and Heritage Foundation health policy expert Nina Schaefer. Among the reforms discussed were personal and portable health insurance and new advances in telemedicine. Outreach


Dr. Goodman spoke about health reform at FreedomFest in July. He analyzed employer options for controlling health care costs at an American Legislative Exchange Council (ALEC) conference in Austin, Texas, in August – cosponsored by the Heartland Institute. He talked about Trump health reform at Florida Southern College in September. He wrote columns for ForbesTown Hall and the Wall Street Journal Nan Hayworth continued to make periodic appearances on Fox News. Thomas Saving was joined by former Sen. Phil Gramm in a Wall Street Journal editorial arguing that the Federal Reserve system has lost its ability to control interest rates. In an article in The Hill, Laurence Kotlikoff revealed an explosive fact: The Social Security Administration is sending workers wrong information about what retirement benefits they can expect to receive. In another editorial, Kotlikoff claimed that banks are ripping off depositors and he updated the case for 100% reserve banking – a proposal he first presented with John Goodman in The New Republic in 2009.