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From the email:

It is with great sadness that Remote Area Medical announces the passing of our Founder and President, Stan Brock. Mr. Brock passed away today in Knoxville, Tennessee at the age of 82. Since he began RAM in 1985, Mr. Brock has been a tireless advocate for those in need, and through his leadership, RAM has provided free care to more than 740,000 individuals.

Without Mr. Brock, RAM would not have been able to prevent pain and alleviate suffering for so many people. While Mr. Brock’s death is a great loss to the organization, RAM will continue championing his legacy and caring for those in need. Mr. Brock built a strong organization led by a dedicated 12-member Board of Directors, 34 staff members, and tens of thousands of volunteers and donors. Together, they will continue to fulfill the mission set by Mr. Brock so many years ago in the jungle of Guyana.

I met Stan for the first time at a Cato Institute conference some years ago, and I was struck by not only the quality of the organization itself, but by the effervescent attitude that Brock brought to providing high quality care, free of charge, to the nation’s poorest and most at-risk individuals. He was a force of nature who was not shy about offering help in a crisis.

But while his personality was larger than life, he always struck me as a humble man intent on finding ways to serve. I join thousands of others mourning his loss but am thankful that RAM, an organization he founded and led for so long, will continue doing the good work he started.

For those seeking more information about RAM, this 60 Minutes segment from 2008 summarizes it well.

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A certificate of need is a legal document the state issues to allow a health care provider to expand, modify, or construct certain health care facilities. In Missouri, a nine-member committee reviews applications for certificates of need and administers them in accordance with its own rules. For example, last year, the Lafayette Health Center received a CON to construct a new $40 million hospital. Based on the committee’s rules, Lafayette likely paid the review committee a hefty $40,000 application fee.

One of the original purposes of the program was to guarantee health care access by limiting competition in a particular region. Proponents assert that, with less competition, the likelihood of a hospital going out of business will be reduced, hopefully ensuring a sufficient level of care for citizens near the health care provider. Yet, empirical evidence suggests that CON programs neither control costs nor improve health outcomes. Indeed, they may actually hamper access to care and patient choice, at least under some circumstances.

If the certificate of need law could be hurting the people it was intended to help, should it be reformed? Abandoned? These questions are central to why we, as Missourians, ought to take a serious look at the necessity and efficacy of the state’s CON program. In future posts, I will review how CON regulations impact health care costs, access to care, and clinical outcomes.

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The Good: The Legislature will submit to voters a referendum that would block the governor from unilaterally implementing ObamaCare. I have written about this in the past and had researched last September what the governor could do unilaterally. I expect Missourians will add an exclamation point to the state’s opposition to the Patient Protection and Affordable Care Act (PPACA) with the referendum, not unlike Missourians did with Proposition C in 2010. If passed, the referendum will deny the governor the ability to impose an ObamaCare health insurance exchange in Missouri.

Moreover, Missouri senators defeated what would have been an extension of the expensive and burdensome kindergarten optometrist mandate, an issue which I testified against. An unnecessary and inefficient imposition on Missouri’s families, the bill’s failure was the right thing for Missourians and Missouri families. This is an all-too-rare example of removing licensing-related rules and regulations in Missouri. I hope we have more of this in the future.

The Bad: In this case, really bad legislation. A bill that would have declared ObamaCare “unconstitutional” and applied criminal penalties to federal officials who would implement portions of the law in the state never made it to a vote on the floor of the Senate. Re-litigating the centuries-old notions of state interposition is neither necessary nor helpful to combating ObamaCare. The bill’s unceremonious end was warranted.

The Sad: Late last week I worried here that a bill allowing volunteer health organizations access to medically underserved Missourians would die due to a small potatoes dispute in one of the bill’s sections. To be clear, both the House and the Senate passed nearly identical versions of the bill. And yet, it died. It is a shame, bordering on shameful  that the chambers could not reconcile their differences.

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Here’s a good bit:

Dr. Baumol and a colleague, William G. Bowen, described the cost disease in a 1966 book on the economics of the performing arts. Their point was that some sectors of the economy are burdened by an inexorable rise in labor costs because they tend not to benefit from increased efficiency. As an example, they used a Mozart string quintet composed in 1787: 223 years later, it still requires five musicians and the same amount of time to play.

Despite all sorts of technological advances, health care, like the performing arts, suffers from the cost disease. So do other public services like education, police work and garbage collection. While some industries enjoy sharp increases in productivity (cars can be built faster than ever, retail inventory can be managed better), endeavors like health care are as labor-intensive as ever.

Here’s another:

At the same time, demand for health care never lets up. So while slow sales of video games or clothing can reduce prices, health care prices never ease. And while the robots that help build cars have replaced human beings on the assembly line, robots that help out in modern operating rooms are not as economically efficient.

“We do now have robots performing surgery, but the robot is under constant supervision of the surgeon during the process,” Dr. Baumol said. “You haven’t saved labor. You have done other good things, but it isn’t a way of cheapening the process.”

It’s important to note, then, that the most effective ways to cut cost inflation given Baumol’s insight is through market-based means: shock the supply or rein in demand in the market. The current health care proposals passed by the United States Senate and House of Representatives do the opposite. As I’ve written before, both proposals would, by expanding coverage or insurance, impose an economic wedge between the price consumers pay and the price producers receive. When this wedge occurs, over-consumption of resources is all but guaranteed. So, effectively, the health care bills will increase demand and thus increase costs beyond the baseline level of inflation.

Fortunately, there are other options. The Show-Me Institute has written before about certain health care reform proposals, like health savings accounts (HSAs), that restrain demand without exacerbating the harmful effects of an economic wedge. Unfortunately, the House bill and especially the Senate bill attack HSAs and make them significantly less attractive.

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Blunt’s proposed plan (details are available on his website) seeks to limit government involvement in health care and instead extend control to patients and doctors. The crux of the plan is to create health savings accounts (HSAs), an issue that the Show-Me Institute has delved into previously. These allow employees and employers to save money to use for future health care expenses, at pre-tax rates. Tax credits and HSAs allow people to keep their health insurance intact, regardless of employment status — a factor that is especially important during our current transient job market. The plan seeks to bring down medical costs through market competition, as well as to institute reforms of malpractice law, which can drive up health care prices unnecessarily.

The president’s plan aims to do the opposite, by creating a large government insurance plan to “compete” with private insurance. Government “competition” in the private market is not the solution, as we have witnessed with Medicaid and Medicare — these plans are guaranteed to receive the lowest rates, but they still drain money. An effective plan would instead actually seek to address the issues facing the health care industry by encouraging market competition and efficiency, rather than just creating Medicaid part II.

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Giving people information about health care options is a great idea. And this website is easy to navigate, and has lots of information. Unfortunately, I don’t think it will be as effective as it should be because it’s more focused on insurance than on health care. The question we should be asking is: Can everyone pay for health care? (There are different ways to pay for care, like using a regular savings account, an HSA, catastrophic insurance coverage, traditional insurance, or some combination of the above.) Instead, this website asks, "Is everyone enrolled in a traditional insurance plan?" and then panics when the answer is no, without considering whether that kind of plan would be appropriate for everyone. Surely, we can all agree that a billionaire doesn’t need traditional insurance to cover routine check-ups, even though he or she might want long-term care insurance or a designated savings account.

This feedback form offers a humorous illustration of the website’s misplaced priorities. Along with basic information like your name, zip code, and email address, you’re supposed to check off whether you are "insured" or "uninsured." But without detailed information about someone’s financial and medical situation, a simple yes-or-no answer to to the "Are you insured?" question doesn’t mean very much.

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