Month: December 2021

Reckoning with insurance for better patient choice in healthcare

A new Senate bill seeks to take the hassle of dealing with healthcare companies away from patients and into the hands of insurance companies. Although it falls short of the mark, this bill is a step in the right direction toward sensible healthcare reform in Pennsylvania.

Regardless of your job, your income, or where you live, we’ve all had at least one nightmare scenario when it comes to health insurance.

There are forms, claims, reimbursement requests, schedules, and negotiations. Doctors, dentists, and health practitioners understand the burden, and often have to face their own bureaucratic tests of will before focusing on their patients. The growth of healthcare administration costs emphasizes this. And that’s for people with private plans.

The price inflation that comes with the amping up of health insurance plans in our entire system — not to mention the role of government subsidies — is a well-known phenomenon. Insurance becomes involved in every rudimentary doctor visit or procedure, leading to bad incentives for health providers, employers, and insurance companies. This process involves a middleman in what should essentially be a simple medical contract between patient and practitioner. 

The answer, however, is not in abandoning free exchange in healthcare, as Medicare For All proponents would have us believe, but rather it is in reckoning with insurance to make our system more competitive and fair.

In Pennsylvania, one particular bill is addressing the process of making insurance more accountable and lowering patient costs and headaches.

This session, State Sen. Judy Ward has introduced SB850 that would enact assignment of benefits reform, compelling insurance companies to follow a patient’s wish to directly pay healthcare providers rather than leaving them with the paperwork and negotiation. This would simplify life for patients by requiring insurers to pay providers directly.

One would think this is standard practice, but especially for dental insurance, there are additional steps and vetting that often leave patients responsible for paying their dentists only after the insurance company has paid out the claim.

Though only a small reform, and leagues from where we need to be to have a truly free market in healthcare decoupled from our employers, this bill would make the entire process simpler and better empower patients and consumers.

Since the Affordable Care Act and large Medicare reforms at the federal level, assignment of benefits is recognized in most medical insurance markets, but not yet for dental patients.

These reforms are complicated by the often cumbersome terms of dental insurance contracts: only portions of care or procedures can be covered by insurance, there are caps on the amounts one can reimburse in a single year, and dentists must navigate these steps to accurately bill their patients without producing a shocking bill. This balanced billing approach is necessary for any medical professional who wants to stay in business.

The answer, however, is not in abandoning free exchange in healthcare … but rather it is in reckoning with insurance to make our system more competitive and fair. 

But the status quo often makes it more complicated than it otherwise would be.

That is why price transparency remains an important principle for these debates, and why legislators should continue ensuring patients have choice and access to the information they need.

There are dozens of easy reforms state legislatures could follow that would help improve care: fostering innovation, reducing bureaucracy, giving incentives to patients to use direct-to-consumer options, and more.

By continuing to promote competition and transparency, patients and consumers can benefit from better care and lower costs. It is only a small degree of change we need, but it beats the alternative.

Originally published here

Counterpoint | Ontario, We Have a Problem

Tanya is joined by David Clement, North American Affairs Manager at Consumer Choice Centre, and Jay Goldberg, Interim Ontario Director at CTF, for an in-depth discussion on Ontario’s debt problem.

Watch the interview here

End the War on Nicotine

Reducing the number of smokers remains public health priority for governments around the world. However, the war against nicotine prevents further progress.

The bad reputation of nicotine is getting in the way of providing smokers with a safer alternative to traditional tobacco cigarettes. A new paper, published by the Consumer Choice Center, aims to debunk myths associated with nicotine and provide some more clarity around what nicotine actually is.

Smoking rates have been steadily declining but it is not thanks to tools applied by the governments,  but rather the innovative alternatives to smoking such as e-cigarettes, snus, etc. Unfortunately, rather than promote an alternative that is far less harmful and gives people a chance to live healthier and longer lives, public officials are waging a war on nicotine. This limits access to those life-saving alternatives. 

Contrary to popular belief, the harm from smoking comes from the thousands of other chemicals in tobacco smoke, many of which are toxic. And while nicotine is an addictive substance, it is relatively harmless and doesn’t increase the risk of serious illnesses (heart attack, stroke) or mortality.

Unlike vaping, conventional nicotine replacement therapies, such as patches, nasal sprays, gums are endorsed by public health bodies. Going against vape and snus just because it is a different way of consuming nicotine is inconsistent, to say the least. NRTs work for some people, but others prefer vaping, and it should be up to consumers to choose their preferred harm-reduction tool. Instead of limiting their choices, we should use all tools at our disposal to help smokers switch.  

Nicotine has been demonised for so long that the health benefits of nicotine consumption have been completely ignored. Research since the 1960’s has demonstrated that smokers show lower rates of Parkinson’s disease, and recently a study suggested the reason for this is nicotine. Another study suggests that nicotine has an appetite suppressing effect and therefore acts as a weight suppressant, and could be used to fight obesity Studies also suggest that nicotine can improve exercise endurance and strength. This explains why many professional athletes use nicotine to improve their performance.

Distorted perceptions about nicotine stand in the way of more smokers switching to less harmful ways of consuming nicotine. Many physicians falsely believe that nicotine is the substance causing cancer in patients. Public health advocates and health experts need to get educated on the topic and encourage smokers to switch to alternatives, such as vaping which is 95% less harmful than traditional cigarettes.  

Prohibition doesn’t work, as demonstrated by the American prohibition era and numerous other examples. Instead, it pushes consumers towards the black market where providing high quality products is not a priority.

Innovative nicotine products have the potential to save millions of lives around the world, and we should not allow misconceptions get in the way of the fight against smoking-induced diseases.

Read our new paper “Six reasons to stop the war on nicotine” to find out more on the topic

Steuerwettbewerb und Verbraucherschutz

Staaten stehen in einer gewissen Konkurrenz zueinander. Zwar ist der Handel kein Nullsummenspiel und Handelskriege, Zöller und andere Beschränkungen daher kontraproduktiv. Dennoch lässt sich nicht leugnen, dass verschiedene Regulierungsmöglichkeiten zu besseren, oder schlechteren Ergebnissen führen. So ist derjenige Staat, der seinen Bürgern und Unternehmen weniger Steuern aufbürdet tendenziell wettbewerbsfähiger, als ein Staat mit hoher Besteuerung. Ein Staat, der das Eröffnen eines Unternehmens erleichtert, wird meistens auch mehr Selbständige haben, als ein Staat, der eine hohe bürokratische Barriere aufstellt. Nur in einer völlig freien globalen Marktwirtschaft würden diese regulatorischen Unterschiede verschwinden.
Diese Ausgangslage haben wir aber nicht. Die Beatles haben sich aufgelöst. Sebastian Vettel wird nicht mit Ferrari Weltmeister und Eltern lieben manchmal nicht alle ihre Kinder gleich stark. 

In dieser von Fehlern behafteten Welt stehen die Staaten durchaus im gegenseitigen Wettbewerb. Das führt zu solchen pathologischen Erscheinungen, wie Protektionismus.

Eine andere Art des Wettbewerbs konnte man vor nicht zu langer Zeit in zwei baltischen Staaten beobachten. So bemerkte man in Estland, dass durch die höheren Alkoholsteuern viele Bürger sich dazu entschieden Alkohol nicht im eigenen Land, sondern bei dem Nachbarn in Lettland zu kaufen. Dadurch entwickelte sich vor Allem in den Grenzgebieten reger Handel, Geschäfte wuchsen wie Waldpilze nach einem Schauer. Die dadurch von dem estnischen Staatshaushalt erlittenen Verluste brachten wie so häufig Wirkung und die Regierung entschied sich die Alkoholsteuern 2019 um 25% zu senken.

Das löste zunächst eine kleine diplomatische Krise aus. So zeigten sich die Letten zunächst bestürzt. Die beiden Staaten hatten sich eigentlich Jahre zuvor darauf geeinigt, dass Lettland die Alkoholsteuern erhöhen werde, was auch schrittweise geschah. Der Premierminister Lettlands beteuerte zunächst, dass er in keinen Alkoholkrieg gegen Estland ziehen wolle. Die mutige Handlung der Estländer zwang Lettland effektiv dazu seine Alkoholsteuern im Gegenzug zu senken. Das Ergebnis war eine Absenkung der Alkoholsteuern um 15%.

Dabei muss eine solche Steuersenkung nicht dazu führen, dass weniger eingenommen wird. 
Polen entschied sich 2002 dazu die Alkoholsteuern radikal um 30% zu senken, um die “grauen Zonen”  zu bekämpfen, in denen illegal und unkontrolliert Alkohol hergestellt wurde. Wegen der Steuersenkung verzeichnete der polnische Staatshaushalt erhebliche Einnahmen, und konnte eine seit Jahren anhaltende Tendenz umkehren. 2002 brachten die Steuern noch 3,87 Mld PLN (881 Mln €) ein, 2003 waren es bereits 4,09 Mld PLN (931 Mln €) und 2004 erfreute sich der polnische Staat über 4,56 Mld PLN (1 Mld €) . Ebenso konnten die Grauzonen bekämpft werden, in denen Alkohol unkontrolliert hergestellt wurde.
Leider lernte Polen nicht aus dieser positiven Erfahrung. Erst gestern, am 02.12.21 entschied der polnische Sejm über eine Erhöhung der Alkoholsteuern und Tabaksteuern. Man argumentierte mit der Sorge um die Volksgesundheit… Die gleiche Regierung führte eine Steuer für E-Zigarettenliquids ein, einer weniger schädlichen Alternative, die eine Preiserhöhung von mehreren Hundert Prozent bewirkte. Volksgesundheit also…

Die Beispiele zeigen zwei Lehren. Einerseits ist eine Steuersenkung nicht immer gleichbedeutend mit einem Verlust der finanziellen Mittel für den Staat. Andererseits ist sie ein geeignetes Werkzeug des internationalen Wettbewerbs, mit finanziellen und gesundheitlichen Vorteilen für den Verbraucher.

Damit ein solcher Wettbewerb entstehen kann, braucht es bestimmte Rahmenbedingungen. Im Falle von Steuern die auf bestimmte Güter erhoben werden ist diese Rahmenbedingung der freie Markt und Freizügigkeit. Beide Staaten sind Mitglieder der europäischen Union. Die oben beschriebene Situation konnte nur entstehen, weil es für die Esten möglich ist ohne größeren bürokratischen und finanziellen Aufwand nach Lettland zu reisen und dort Waren einzukaufen.

Das Prinzip ist aber auf viele Arten von Steuern anwendbar. So können Staaten und Regionen auch gegeneinander konkurrieren indem sie Lohn- und Einkommensteuern, Kapitalmarktsteuern, Grundsteuern und andere Abgaben kürzen. Dieses Prinzip sieht man auf dem europäischen Kontinent in dem Beispiel des schweizer Föderalismus. Dort konkurrieren Kantone gegeneinander u.a. mit der Steuerlast. So zahlt man in dem im Zentrum des Landes gelegenen Kanton Zug tendenziell weniger Steuern als in den westlichen Gebieten in unmittelbarer Nähe zu Frankreich.

Ein größeres Land mit einer föderalen Struktur die Steuerwettbewerb begünstigt sind die USA. So erheben gleich neun Staaten in den USA (Wyoming, Washington, Texas, Tennessee, South Dakota, New Hampshire, Nevada, Florida, Alaska) keine eigenen Einkommensteuern. Das ist ein nicht unerheblicher Unterschied zu dem Bundesstaat Kalifornien, das eine Steuer von 13,3% erhebt. Unterschiede ergeben sich auch in Details, wie der Progression. So erheben Staaten wie Illinois, North Carolina, oder Minnesota zwar durchaus Einkommensteuern, diese allerdings in Form einer “flat tax”, einer Liniensteuer.
Große Unterschiede gibt es auch bei Verkaufssteuern (sales tax) und anderen Abgaben.

Sowohl in den USA als auch in der Schweiz haben die Bürger somit die Wahl zwischen verschiedenen Modellen von Besteuerung und können mit ihrem Einkommen und den eigenen Füßen abstimmen, indem sie einen anderen Wohnort wählen.

Diesen Mechanismus kann man auch in der EU beobachten. Einen solchen Vorteil des europäischen Föderalismus gilt es zu wahren und zu verstärken. Anstatt Mindeststeuersätze einzuführen (die Beispielsweise bereits bei der Mehrwertsteuer gelten) sollte die Europäische Union den Wettbewerb vielmehr gutheißen. Vorteile würden sich nicht nur für den individuellen Steuerzahler in der EU ergeben, sondern für die gesamte Freihandelszone. 
Eine niedrigere Besteuerung, die durch den Wettbewerb erreicht werden könnte, würde die europäischen Unternehmen konkurrenzfähiger auf dem internationalen Markt machen. Die EU sollte im Zusammenhang von Steuern also weniger von Solidarität und mehr von Föderalismus und Dezentralisierung sprechen.

New survey shows MEPs know worryingly little about vaping

According to the findings of the new ECigIntelligence survey, 57 per cent of Members of the European Parliament have no knowledge of vaping (with 16 per cent not even being aware of its existence).

Given that European politicians are now determining Europe’s approach to vaping, these results are extremely worrying.

ECigIntelligence surveyed Members of the European Parliament (MEP) for the second time (the last survey was in 2020). The results show that many MEPs continue to be misinformed or uninformed about vaping and other less harmful smoking alternatives.

Maria Chaplia, Research Manager of the Consumer Choice Center, commented on the survey: 

“Currently, 140 million people in the European Union still smoke, and most of them struggle to quit. It is key that European policymakers have sufficient knowledge of life-saving alternatives such as vaping and their potential to tackle this problem. The low awareness signals an increased risk of making the wrong decisions that could cost Europe lives of current and future smokers. The MEPs should take these issues more seriously and open their minds to a growing plethora of studies on vaping.”

Key findings of the survey: 

  • More than a third of MEPs have no knowledge of any new nicotine product (vaping, heat not burn, pouches), and over one in ten are not even aware of them.
  • Incredibly, 28% believe that vaping is as harmful or more harmful than smoking, and a further 18% don’t know at all.
  • Also, 16% incorrectly believe that vaping is likely to lead non-smokers to smoking cigarettes. 
  • On flavours, the worrying trend from last year continues. 53% are in favour of regulating flavours the same or even more than cigarettes.

“The World Health Organisation’s misguided recommendations against vaping have skewed the discourse against evidence-based policymaking in Europe and across the world. Vaping is 95 per cent less harmful than smoking. Vape flavours help smokers quit once and for all, and nicotine is not our enemy. It is crucial that the stigma around vaping ends before it is too late,” concluded Chaplia.

CCC joins coalition opposing Sohn’s federal communications commission nomination

A coalition of 18 center-right organizations sent a letter to the Senate opposing Gigi Sohn’s nomination to serve as a Commissioner on the Federal Communications Commission.

Sohn has spent decades as a hyper-partisan activist, launching attacks against regulators and elected officials who do not share her views. All of which has been well documented on social media. The letter outlines her past positions and how, if confirmed, Sohn would work to instill policies that would crush innovation, silence conservative speech, and eviscerate intellectual property protections.  

December 1, 2021  

Dear Senators:  

We, the undersigned, represent a broad coalition of organizations who oppose the nomination of Gigi Sohn to serve as Commissioner at the Federal Communications Commission. If confirmed, Sohn would work to instill policies that would crush innovation, silence conservative speech, and eviscerate intellectual property protections.  

The FCC was created by Congress to be an independent regulator and it has broad power over the telecommunications, media, and technology sectors. The agency has been characterized by bipartisan cooperation and accountability to Congress.  

Sohn has spent decades as a hyper-partisan activist, launching attacks against regulators and elected officials who do not share her views. She implied that the ranking member of the Senate Commerce Committee is an industry puppet. She suggested that Republican senators are a threat to the country. She credits center-right news outlets with “destroying democracy” and “electing autocrats.” And she joined the board of an organization after it was sued by major broadcasters for violating the Copyright Act—a case that recently resulted in a $32 million judgment against her organization. Given these views, it is hard to believe that Sohn would give regulated entities a fair shake or operate in a bipartisan manner at the FCC.  

The FCC plays a critical role in protecting and upholding free speech and the First Amendment rights of regulated entities. Sohn’s willingness to use the FCC’s power to silence her opponents is disqualifying on its own.  Sohn has expressed interest in the FCC revoking hundreds of broadcast licenses from a particular broadcaster due in part to the editorial decisions that company has made. She supported a campaign by elected officials to pressure cable and streaming services to drop conservative news outlets. And she closely aligns with an organization who petitioned the FCC to investigate broadcasters whose COVID-19 coverage they disagreed with.

Her views on Title II are emblematic of her longstanding tendency to promote policies that over-regulate the industries in the FCC’s jurisdiction. Sohn was one the chief architects of the short-lived Title II common-carriage rules that she claimed were necessary to enforce net neutrality. The rules drove down broadband investment,  increased prices, and decreased the adoption of home Internet service. Sohn has made it clear that she not only wants to reinstate these rules, but wants to take them further, including a ban on “zero-rating,” the free wireless data services that are particularly popular among low-income users. She has also signaled a desire for the FCC to set the price of broadband service, a practice that would be more apt for the Soviet Union than the United States.

When the rules were being repealed by the prior administration’s FCC, Sohn encouraged the far-left activist campaigns that fueled hyperbolic and doomsday predictions about the destruction of the Internet. FCC commissioners received death threats and a bomb threat was called into the FCC moments before the vote to repeal the rules. Sohn works with and supports the organizations who engaged in the tactics and rhetoric that led to these ugly displays.

Throughout her career, Sohn has favored policies that undermine intellectual property rights protections. She spearheaded an FCC proceeding that would have enabled tech platforms to effectively steal and monetize television content without paying for usage rights. Sohn also served on the board of Locast, a “non-profit” that was determined to be illegally retransmitting broadcasters’ content without their consent in violation of the Copyright Act. The case resulted in a permanent injunction that required Locast to pay $32 million in statutory damages. Sohn cannot be an impartial regulator of the broadcast industry after joining the Board of an organization that openly violated that industry’s copyrights. 

As the decisive vote on controversial matters at the agency, Sohn would have the power and incentive to push the FCC towards government control of communications. Further, the Biden Administration has shown a willingness to mislead Senators when it comes to agency leadership, as demonstrated by the bait-and-switch the White House pulled with the Federal Trade Commission, when Chair Khan was elevated after being confirmed under false pretenses. The potential for Sohn to become chair of the FCC makes her nomination all the more concerning. 

Sohn’s confirmation would jeopardize investment and innovation, threaten free speech, and bring partisanship to the FCC. For these and other reasons, we urge Senators to reject Sohn’s confirmation. 

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