October 25, 2013

"ObamaCare 2016: Happy Yet?/The website problems were finally solved. But the doctor shortage is a nightmare."

An interesting WSJ column by Bradley Allen, a pediatric heart surgeon, painting a nightmare scenario that's very heavy on predictions of doctors serving their own self-interest:
With the best and most successful doctors disappearing into concierge medicine or refusing new Medicare and Medicaid patients, replacing these experienced physicians with bright young doctors to work with the "general public" has become difficult. Why? Because such doctors are hard to find — going into medicine doesn't have the professional allure it once did.
This is the perspective of a doctor, who believes his profession is highly elite and deserves to be treated that way, but I think he's a little blind about the continuing ability of doctors to opt out of the system. Won't they be compelled to participate? I don't think they can be compelled to work if they choose to retire from the practice of medicine, but why wouldn't the government's system evolve into something that subsumes all medical practice? If there are shortages that frighten and distress the people, the doctors' options will, I predict, shrink.

Must the "professional allure" be preserved? Apparently, it's already gone. Who will want to be a doctor now? As the nightmare unfolds, we will find out. Old doctors are always checking out and the system is always producing new doctors (and other medical professionals). Who will they be and what will happen? Maybe in the future we will dispense with pediatric heart surgeons. We got by without pediatric heart surgery before 1956. I'm picturing lots of nurses and lots of palliative care.

124 comments:

El Pollo Raylan said...

I'm picturing lots of nurses and lots of palliative care.

That exactly right, Althouse. An army of Ingas, and a slew of available palliative meds.

traditionalguy said...

A local trend for a year has become using a known names, such as Emory Clinic, to buy-up the medium and small Medical practices and run them their way.

Some larger Medical Practices are staying independently owned, so far, but retirement age will approach for them too in 10 years.

It seems that a patient's "Medical Doctor" time is disappearing and patients only get to see a Physician's Assistant.

To mask that dearth of MDs the industry has been acquiring, renting or erecting large Doctor's Offices under the new Clinic Name. That in turn has made medical space near Hospitals become a boom market.

The Federal Gold Flow funds the only industry that can now afford to pay the higher rents in these areas.

AustinRoth said...

Yes, lets just rid ourselves of those pesky specialists.

Why eliminate just pediatric heart surgeons? Let's get rid of all heart surgeons.

No more brain surgeons, OB/GYN, cancer specialists, whatever.

We can go WAY past the 1950's, to the 'good old days' when your barber was also your Doctor.

That will reduce medical costs, especially as we cull the herd of all those excess sick and old people that are such a financial drain on the system.

cassandra lite said...

Of course we got by without pediatric heart surgery before '56. And kids died who could've been saved if it had.

I know Brad Allen. For years he's lamented that the best minds of his generation, to borrow a line, either opt out of medicine or don't go into medicine or talk their kids out of a career in medicine. Which of course means that another specialty that doesn't exist in 2013 might not come into existence, as pediatric heart surgery did when great minds pursued it.

He likens medicine to flying--what flying used to be versus what it's become. That's not from the POV of a pilot but from the patient's perspective. Unless you can afford to fly first class, you're essentially in a cattle car.

As for the (medical) pilots, too many Sullenbergers are taking their talents elsewhere.

jacksonjay said...

This jackass of an arrogant pediatric heart surgeon should more humble. Like every lawyer I ever knew!

Sorun said...

One of the best doctors out there today is Dr. Google. In the future, diagnosis with be done with computer algorithms. We'll still (probably) need real live doctors for surgeries, etc, but not so many.

My last doctors visit was mostly spent on a discussion of family medical history. That could be dealt with more efficiently with a DNA test.

Lance said...

Yes, by all means let's force people who don't want to provide health care to provide health care.

In fact, everyone should be required to provide some health care every year, as a civic service. Like jury duty. Only with tongue depressors, narcotics, and scalpels.

Strelnikov said...

"predictions of doctors serving their own self-interest"

So?

I'm reminded of Hillary at a public meeting during the run up to HillaryCare's failure. When confronted by a med student who wanted to fulfill her dream of practicing a given specialty, H intoned in her very best iceberg impression, "You'll have to sacrifice your dream for the common good." Again, why?

Because your betters say so.

Paddy O said...

"You'll have to sacrifice your dream for the common good."

That's great advice for Hillary to follow.

Inga said...

Does Germany, France, England, Australia, Canada, Italy, Japan, Singapore, the Netherlands, Switzerland and more countries with socialized medicine have pediatric heart surgeons?

So we're back to death panels and doctors leaving their exclusive specialties or practices altogether again? Do doctors in Germany, England, France, Australia and Canada live in poverty?

Jim said...

Let's remember that Michael Jackson had "concierge medicine." I think the best medicine is to be had by someone who is in the trenches every day.

Henry said...

Allen has a point, but he misses some of the technological changes that are happening out of his immediate purview.

My health plan just pushed out a video app in which you can talk to a doctor 24/7. This remote, impersonal care sounds like Dr. Allen's complaint, but it actually has a lot of upside. Over the last few years we've called the doctor maybe a half dozen times for very simple questions: "My young child has this illness; what over-the-counter medicine is recommended?" "I'm experiencing these symptoms, should I go to a clinic?"

Many large pharmaceutical companies are running highly-automated script-filling laboratories to send patients their medications by mail order. This is hugely convenient.

Sure you may miss your interaction with your local pharmacist, but that assumes that your local pharmacist is actually helpful.

marvin said...

These "doctor moans about the future of health care" pieces always seem to come from an alternate universe.

The number of medical school applicants has skyrocketed since (up 30% between 2001 and 2012). The number of matriculants has seen less of an increase, but is still up 20% over the same time period.

And it's not like applicant/matriculant quality is declining either, MCAT scores are up ~ 1.5-1.6 and GPAs are up ~ .8-.9 points for applicants and matriculants over the same time period.

The actual trend is that doctors coming out of medical school are both brighter and more numerous than the classes that preceded them. And with the continuing replacement of ye olde family doctor with PAs and NPs, more of those doctors are specializing than ever.

Health care doom may come from somewhere, but is certainly isn't going to be from doctor shortages due to "opting out".

cubanbob said...

"This is the perspective of a doctor, who believes his profession is highly elite and deserves to be treated that way, but I think he's a little blind about the continuing ability of doctors to opt out of the system. Won't they be compelled to participate? I don't think they can be compelled to work if they choose to retire from the practice of medicine, but why wouldn't the government's system evolve into something that subsumes all medical practice? If there are shortages that frighten and distress the people, the doctors' options will, I predict, shrink."

Seriously? Ann as a law professor just for the sake of discussion can you provide us with a constitutionally plausible legal theory that government, both state and federal that can subsume all medical practice?

El Pollo Raylan said...

A "big government" solution to a doctor shortage is to subsidize tuition for doctors and nurses ala post Sputnik funding of science education. This would lead, as it did for science, to a glut of very talented practitioners, who would work just as hard for next to nothing. But in the long run, this would not be a good thing as people would leave again as they did science careers. Also, such a scheme would have to be coupled with tort reform--as if that will ever happen.

Hagar said...

The specialists will be attached to large hospitals and clinics which will find ways to protect themselves and stay in business, but they will become more like the VA as far as service and bureaucracy goes.

Private practice primary care, or "family doctors," will get very scarce. Some will go "boutique," some will go "cash & carry," some will become authors or stockbrokers.

Thus the medical care that is most needed will continue to be dispensed by hospital emergency rooms and possibly "Walmart" storefront operations with one doctor supervising a staff of nurses and technicians, assuming State laws and regulations will be relaxed to allow this.

And the poor will still be SOL.

Inga said...

Again, do doctors in countries with socialized medicine live in poverty? Do they earn "next to nothing"? That is beyond silly.

The Drill SGT said...

Inga, what those Canadian and UK Docs are is Government employees.

The article talks about how docs in private practice work 70-80 hours a week, But after they sell the practice and go on the hospital clock its 40 hrs. Thus you have a 40% doc shortage.

Very interesting stories in the UK tracking surgery counts by month. As the FY comes close, all the surgeons have hit their yearly quota, surgeries drop, and folks start dying while waiting for next FY. Guviment Medicine

Not trying to start another fight, but the feminization of medicine will increase the problem of Doc shortages. As the Female Doc ratio increases, the lifetime Doc productive hours will decrease.

Say a Male Doctor Welby worked an average of 60 hours weeks from 30-70. Call that 120,000 hours of doc'ing.

Some Female Docs will be working 30 hours a week for 20 years, perhaps 30,000 hours over a career at the low end...

PS: Male docs join private practices, female docs tend toward hourly employment...


Ann Althouse said...

"Does Germany, France, England, Australia, Canada, Italy, Japan, Singapore, the Netherlands, Switzerland and more countries with socialized medicine have pediatric heart surgeons?"

I don't know. What is the likelihood that a baby with a defective heart will get it repaired? Is that the most efficient use of resources? How many overweight adults can be advised about nutrition and exercise for the price of fixing one baby? How many sexually active women can be prevented from producing new babies for the cost of fixing one infant's heart? These are questions that will need to be answered. How have they been answered in Germany... over the years?

somefeller said...

Yeah, when Medicare and Medicaid were enacted, one heard claims about how doctors were going to opt out en masse. Some did, until they noticed that their colleagues were doing fine in the new system. In any case, the medical profession didn't collapse or become impoverished. Plus ca change, as they say in Galt's Gulch.

Lance said...

Do doctors in Germany, England, France, Australia and Canada live in poverty?

For a Marxist, that's a second-order concern. The immediate issue is: do those countries have enough doctors?

Inga said...

How much do doctors in other countries make?

Henry said...

Another thing to remember is that any culture with adequate nutrition, clean drinking water, and childhood immunizations is going to have relatively good health outcomes, no matter who the doctors are. So broad-based statistical measures of Western countries doesn't really tell us anything about the capability of doctors or the quality of care.

Dr. Allen's dystopia will be effectively unmeasurable. This will be very convenient for those who wish not to notice it.

SGT Ted said...

They are going to have to go back to how it was in the 50s, where most doctors didn't work for elite paychecks, but had to rely on the patients ability to pay.

The distortions of the market caused by the Frankenstein's Monster stitched together by laws pushed by corporate and government special interests in the healthcare insurance market, trying to require third party payments to hospitals and doctors mandatory for every day affordable medical things has resulted in what we have now before ObamaCare really destroys the market.

Doctors and healthcare corporations used government regulation of the insurance market to guarantee themselves big dollar paydays from insurance companies. No one talks about that part much, instead preferring the fa├žade of the Noble Physician Elite Class, standing between death and us little people.

Also, no one in the political debate talks about the high costs that insurance administrative costs for doctors offices has on the bottom line.

Here is an example of actually letting the market work when the doctor and patient don't have insurance in their way and costs dropping:

http://www.inquisitr.com/679180/maine-family-doctor-ditches-health-insurance-goes-direct-pay/

This article illustrates what could happen to costs if we can get insurance companies out of all but catastrophic coverage and can get primary practice doctors off of the government/insurance racket teet.

Time to ditch insurance except what is affordable in an open market to individuals, have catastrophic coverage instead of 'pay for every little thing' plans that encourage overbilling and refusal of care to save profits.

The Drill SGT said...

Many large pharmaceutical companies are running highly-automated script-filling laboratories to send patients their medications by mail order. This is hugely convenient.

Sure you may miss your interaction with your local pharmacist, but that assumes that your local pharmacist is actually helpful.


One of the places where IT is super is in the area of drug interactions. My little 70 y/o doc uses a PC based Script writer and most hospitals do as well. Alerts can be pushed as patches from the service.

- patient weight age, glucose, etc can be used to trigger dosage warnings.

- complicated drug interaction warnings can be flagged. They don't stop the doc from writing, but they alert.

- same with suggestion new generics

it catches mistakes that used to fall to the Pharmacy or to bedside nurses to catch on a random basis are now systematically screened out

cubanbob said...

"And it's not like applicant/matriculant quality is declining either, MCAT scores are up ~ 1.5-1.6 and GPAs are up ~ .8-.9 points for applicants and matriculants over the same time period.

The actual trend is that doctors coming out of medical school are both brighter and more numerous than the classes that preceded them."

Marvin if you are going to argue stats then let us know how many of the applicant/matriculants are foreign students and how many of those will remain here to practice.

Maybe I've missed it but I haven't seen the numbers of doctors willing to take Medicaid patients increasing.

Inga said...

International Office: Pediatric heart Surgery

Tyrone Slothrop said...

... but why wouldn't the government's system evolve into something that subsumes all medical practice?

Bingo. The system is designed to be unworkable. The present paradigm has to be destroyed so that the government healthcare behemoth can rise out of the ashes. Unfortunately, the best minds will go to Wall Street or, God forbid, the law instead of into medicine.

cubanbob said...

Strelnikov said...
"predictions of doctors serving their own self-interest"

So?

I'm reminded of Hillary at a public meeting during the run up to HillaryCare's failure. When confronted by a med student who wanted to fulfill her dream of practicing a given specialty, H intoned in her very best iceberg impression, "You'll have to sacrifice your dream for the common good." Again, why?

Because your betters say so.

10/25/13, 11:13 AM

Yes I can see her 2016 campaign slogan: "Mother of Obamacare".

El Pollo Raylan said...

marvin advises...The number of medical school applicants has skyrocketed since (up 30% between 2001 and 2012). The number of matriculants has seen less of an increase, but is still up 20% over the same time period.

This sounds pretty rosy. So there's really no reason to be concerned is there?

Hagar said...

"Socialized medicine" is where the national governments expropriate the hospitals and clinics and make doctors, nurses, and staff government employees. That is not going to happen in the U.S., so bringing that up is not really helpful to the discussion as to what might happen here.

However, Inga, my sister lives in the U.K, has cancer, and is dependent on the NHS for treatment.
I do not like to hear my sister cry.

marvin said...

Marvin if you are going to argue stats then let us know how many of the applicant/matriculants are foreign students and how many of those will remain here to practice.

3% of applicants are foreigners. 1% of matriculants are foreigners. As the numbers show, foreigners represent a trivial percentage of medical students in America. They're better represented in residencies, but almost all of them are trying to find work here which would increase the supply of doctors, not decrease it.

Maybe I've missed it but I haven't seen the numbers of doctors willing to take Medicaid patients increasing.

Different sort of doom. Medicaid patients suck because the pay is poor and they drive paying insurance patients from your waiting rooms. Unless you're desperate to build a patient base, you don't take them. And really, not relevant to this discussion.

mrs. e said...

"Marvin if you are going to argue stats then let us know how many of the applicant/matriculants are foreign students and how many of those will remain here to practice.

Maybe I've missed it but I haven't seen the numbers of doctors willing to take Medicaid patients increasing."

7 years ago, the University of Wisconsin School of Medicine and Public Health added a rural, underserved program of 25 to it's existing 150 member class. These applicants are under the same requirements for admission, with additional screening to try to ensure their return to rural/underserved Wisconsin. Also, the Medical College of Wisconsin has plans for expanding their teaching presence into rural Wisconsin.

These two programs plus UWSMPH's urban, underserved program will no doubt be dealing with high numbers of Medicaid recipients.

mikee said...

My wife - a pediatrician in a large practice - has as a coworker a German who rails against the US, because it does not have Germany's universal coverage.

Why is he here, instead of there? Because there he would make $50k a year, instead of $300k.

Remove the individual incentives, and you'll have lots of 3rd world immigrants (very smart, capable people) being immigrant doctors here, instead of US citizens who might not want to work as government wage slaves.

marvin said...

This sounds pretty rosy. So there's really no reason to be concerned is there?

Nah, the doom and gloom if it comes would come from different sources.

The male/female ratio and "work life balance" culture is seriously decreasing the number of hours and number of years that doctors work. Increased residency requirements (yay for research) also slices off a year or two from the front end. The increase in the number of doctors mostly offsets that, but may not meet the increased medical needs of Americans as we age as a country. There's also a concern that the mix of specialists won't match the needs of America going forward. (Read: less ob-gyn, More: rheumatology)

Primary care is going to get worse. You used to get plenty bright doctors working the primary care beat. Not really the case any more with how specialized medicine is becoming. While NPs and PAs are good at what they do, it's hard to argue that they do it as well as fully trained doctors.

But yeah, a shortage of high performance specialists is probably the last thing I'd worry about regarding the future of American health care.

Fritz said...

The same model could be applied to law and law professors. After all, lawyering is expensive. We need to control the costs.

Inga said...

The differences in salaries in the US and other countries, not as much as you might expect

Inga said...

Backing up what Marvin has said. A record number of students applied to and enrolled in the nation’s medical schools in 2013, according to data released today by the AAMC (Association of American Medical Colleges).

The total number of applicants to medical school grew by 6.1 percent to 48,014, surpassing the previous record set in 1996 by 1,049 students. First-time applicants, another important indicator of interest in medicine, increased by 5.8 percent to 35,727. The number of students enrolled in their first year of medical school exceeded 20,000 for the first time (20,055), a 2.8 percent increase over 2012.

“At a time when the nation faces a shortage of more than 90,000 doctors by the end of the decade and millions are gaining access to health insurance, we are very glad that more students than ever want to become physicians

Inga said...

http://theincidentaleconomist.com/wordpress/but-no-one-will-want-to-be-a-doctor/

Birkel said...

"I don't think they can be compelled to work..."

How very noble of the Good Professor to think the 13th Amendment may still be operative. (I suspect the Professor was using her normally understated tone of derision and do not think she could or would think differently about the issue of slavery.

And here I thought the question of slavery had been settled by the United States' first Civil War.

When did we decide that it was no longer "my body, my choice" with respect to things beyond abortion, I wonder.

HAHAHA

It's almost as if President Obama was unable to command the tides away from his chair. Or to repeal gravity. Or the unbreakable laws of economics.

The mind boggles in contemplation of Obama's response when he is told his Executive Orders cannot undo human nature.

I smell a "Hitler in the Bunker" episode!!!!!

gregq said...

"I think he's a little blind about the continuing ability of doctors to opt out of the system. Won't they be compelled to participate? I don't think they can be compelled to work if they choose to retire from the practice of medicine, but why wouldn't the government's system evolve into something that subsumes all medical practice?"

I believe the technical term for that is Communism.

"With the best and most successful doctors disappearing into concierge medicine"

Either they're allowed to work for themselves, or you need to get the 13th Amendment repealed so we can properly fit them into their role as slaves of the government. Because what "concierge medicine" means is you go there, and you pay out of pocket. No insurance, no government, just private individuals engaging in a private transaction.

If you're planning on making that illegal, we've got much bigger problems than how high your insurance premiums are going to be.

CatherineM said...

The Drs will all be from India and China.

Original Mike said...

We'll all be gettin' the Blue Pill.

gregq said...

Ann Althouse said...

... How many sexually active women can be prevented from producing new babies for the cost of fixing one infant's heart? These are questions that will need to be answered. How have they been answered in Germany... over the years?

Hey, that's easy, we can just set up a mass production line a sterilize them all. I believe the Germans had some experience with that a few years back....

How about "the answer to that question is none of 'society's' business"? If I can afford to get health insurance that will pay to have my baby's heart fixed, then I should be able to do it. If you can't, or don't value it enough to do it before hand, you can't.

It's called capitalism, you might have heard of it.

Inga said...

"The Drs will all be from India and China."


"3% of applicants are foreigners. 1% of matriculants are foreigners. As the numbers show, foreigners represent a trivial percentage of medical students in America."

Inga said...

I think we have seen an epistemic closure here. Not much more to be said. They will believe what they want and continue to disregard statistics based in reality.

Tibore said...

"Who will want to be a doctor now?"

Strictly anecdotal here, but out of 13 people I knew at the start of my college career who intended to become doctors, 2 are now such and wouldn't have it any other way, and 8 of the remaining say if they'd do it over again, they'd do something else (the 3 left over I've simply lost contact with and don't know what any of them eventually ended up doing).

And there was the shocking panel of first year residents who were brought in front of our chemistry class and, when asked after the class, all three said they'd choose a different career if they had a chance to do it over again.

This kills me. I have a lot of doctors on my dad's side of the family, so there's a high respect level for the profession. But back then (early 90's) speaking with age peers and others who just recently became doctors, it quickly became apparent that the profession was losing its allure for a long list of reasons. And that's both sad and bad. Bad because the general profession's level of competence just needs to be sky-high, and sad because it's such a sea-change from the positivity my parents and relatives had about the profession. Cynicism can be a pernicious thing, and I don't want to see the medical profession lessen in terms of competence or professionalism because of that. Our lives literally depend on them.

Curious George said...

"Ann Althouse said...
"Does Germany, France, England, Australia, Canada, Italy, Japan, Singapore, the Netherlands, Switzerland and more countries with socialized medicine have pediatric heart surgeons?"

I don't know. What is the likelihood that a baby with a defective heart will get it repaired? Is that the most efficient use of resources? How many overweight adults can be advised about nutrition and exercise for the price of fixing one baby? How many sexually active women can be prevented from producing new babies for the cost of fixing one infant's heart? These are questions that will need to be answered. How have they been answered in Germany... over the years?"

Let's change "babies" to "Gay Son" and "Heart" to "AIDS". As in "How many overweight adults can be advised about nutrition and exercise for the price of keeping alive one gay man with AIDS because he put an infected cock in his ass"?

This is another question that needs to be answered.

gregq said...

marvin said...

The number of medical school applicants has skyrocketed since (up 30% between 2001 and 2012). The number of matriculants has seen less of an increase, but is still up 20% over the same time period.

And it's not like applicant/matriculant quality is declining either, MCAT scores are up ~ 1.5-1.6 and GPAs are up ~ .8-.9 points for applicants and matriculants over the same time period.


MCAT scores are given out on a curve, top X% get a 15, next Y% get a 14, and so on on down. The %'s change between the three tests. So if the number of acceptances is going up, AND the average scores of those accepted is going up, either the company giving out the scores is making the scoring easier, or there are a lot more people taking the MCAT, or there were a lot of people who take both the MCAT and the LSAT, and the high scorers are deciding to go to Med School rather than law school because of the law school implosion.

There is absolutely nothing you can determine about the quality of the matriculantes based on that information, because MCAT scores are relative numbers not absolute numbers, so you can not meaningfully compare them from year to year (unlike the SAT, for example).

AS for the GPA numbers, what were their fields of study? A 4.0 in English means something very different than a 4.0 in Physics. Thrown in with the ongoing grade inflation, again, the number sound pretty, by prove nothing.

There are only so many bright people born in the world every year. If more of them in the US are going to Med School, and fewer are going to Law School, that's probably a good thing.

But if they're just going to Med School because they think that's where they're going to make the most money, rather than because they desperately love medicine, then all you all "there's no problem" people are going to be very upset in 10 years.

Basil said...

Gregg, its not "capitalism" its "freedom". Capitalism the the name given to freedom by the totalitarians so they can more easily control the "masses" who are really the "citizens." What you describe is two free people acting freely. What Althouse describes (approvingly???!!!) is slavery.

Tibore said...

"The number of medical school applicants has skyrocketed since (up 30% between 2001 and 2012). The number of matriculants has seen less of an increase, but is still up 20% over the same time period.

And it's not like applicant/matriculant quality is declining either, MCAT scores are up ~ 1.5-1.6 and GPAs are up ~ .8-.9 points for applicants and matriculants over the same time period.

The actual trend is that doctors coming out of medical school are both brighter and more numerous than the classes that preceded them. And with the continuing replacement of ye olde family doctor with PAs and NPs, more of those doctors are specializing than ever."


Oh, that's good to read. That's why real surveys need to be done over anecdotes. What I observed could engender a real cynicism in people, but if the trends are positive and contradict that, then that's a good thing. I'm happier about this than what I heard and saw back in the early 90's.

Levi Starks said...

Compel?
Why certainly.
Which is exactly why by constitutional standards healthcare can never be a right.
I'll try to explain:
Healthcare is a Right.
Once something is a right we are entitled to an unlimited amount of it.
There isn't an unlimited amount of healthcare available.
Those who are able to provide the limited amount of healthcare which does exist, must if necessary be conscripted to provide that care.
Because It is a Right.
The "Rights" actually detailed in our founding documents do not require the taking resources from one citizen in order to provide for other citizens.
The "Rights" as detailed in the constitution are the rights to remain unmolested from the hand of government, or other citizens. It's makes no difference if the intent of government is good, or bad.
Certainly, Congress as the ability to pass legislation to enact laws to provide in ways they see fit. But to define a non-right as a right skews the argument, and makes it impossible to have a rational discussion.

eric said...

I think for once Inga has a very good point. Medicine is wonderful in these other countries and they have plenty of doctors and everyone is happy.

Thinking of that brought on some other thoughts. Ideas, as it were.

We are changing healthcare in the United States because everyone deserves access to affordable healthcare. And it's so good, we need to force everyone to participate. But this goes a step further. We don't just want everyone to have healthcare, because everyone already does (Via the emergency room, which is not satisfactory) but we want everyone to have access to equal healthcare.

We want everyone to have good, solid, healthcare.

Well, guess what other problem the USofA has? We've got too many people in prison. Being sick is kind of like being in prison, isn't it? Being in prison really sucks. Shouldn't everyone in the USofA have equal access to good, quality, lawyers?

Being I think this is clearly the case, we should make the Affordable Lawyer Act. This will force everyone into a pool where you have to pay a monthly fee and no one will get access anymore to unfair, "High powered" lawyers. Instead, all lawyers would be reimbursed by the lawyer insurance agencies that the people are paying into.

Private laywer practices would be outlawed and we would have single payer lawyer services in the USofA.

That would work, right Ann?

Alexander said...

So we need panels now, to decide who gets to live and who doesn't?

Wish we had a name for that.

Michelle Dulak Thomson said...

Ann,


I don't know. What is the likelihood that a baby with a defective heart will get it repaired? Is that the most efficient use of resources? How many overweight adults can be advised about nutrition and exercise for the price of fixing one baby? How many sexually active women can be prevented from producing new babies for the cost of fixing one infant's heart? These are questions that will need to be answered. How have they been answered in Germany... over the years?


You are assuming that advice from doctors about obesity and birth control will actually be taken to heart, and that it's not available everywhere, for free, online.

This

How many sexually active women can be prevented from producing new babies

creeps me out a bit, Ann. It sounds almost as though you want women to be stopped from having children, not taught how to avoid pregnancy if they want to.

Oh, and one thing about congenital heart defects: They are very frequent in Down Syndrome children. Granted that most of these children end up aborted anyway, often at the urging of doctors who seem to have forgotten the opening of the Hippocratic Oath, but those who make it to birth often need heart surgery (also, often, gastrointestinal surgery). So your hypothetical weighing of benefits actually is, much of the time, the life of one mentally retarded infant vs. heaven knows how many obese patients being told by their doctors what pathetic lardasses they are. I don't know about you, but I still vote for the kid.

AJ Lynch said...

Many many resentful [aka most libruls] people resent well paid doctors. They don't care how many years the doctors invested in school - they just want to penalize them for being a high earning person and cut them down to size and turn them into a NHS drone.

n.n said...

eric:

That's a good point. The availability and affordability of competent legal representation can make or break businesses and private individuals alike.

This is clearly a problem with progressive interventions of governments into the social and economic markets and the predisposition of unscrupulous public servants, and their bureaucratic staff, to engage in monopoly formation or monopolistic behaviors.

It is also a problem with ostensibly civil rights corporations, union corporations, and other activist businesses (e.g. environmental) when they exploit unsavory or questionable tactics in order to coerce payment for their services.

This is notably a problem in the education sector, where expenses are progressive with a regressive return, but also in other sectors of society where the consequences of unearned legitimacy have taken their toll on the viability and integrity of the population.

Anyway, I support your call for affordable legal care. I wonder if people would be willing to pay for the representation of human beings waiting to be born. Their unheard voices are easily lost in several thousand pages of health care "reform".

Illuninati said...

I'm not worried about the supply of doctors. There are plenty of foreign trained medical school graduates who would be willing to work here.

In comparing physician compensation it is important to factor in how much a physician in training spends and also how much the average physician in practice is harmed by medical malpractice lawsuits.

The death panels will undoubtedly be an important part of the medical establishment. This will take two different routes. Some treatments will never become available to anyone because the panel decides that the cost to expense ratio doesn't meet the governments needs. The other part will be actual denial of care for people because of their age etc. People above a certain age will be excluded for expensive treatment because of their age.

Paul Zrimsek said...

I smell a "Hitler in the Bunker" episode!!!!!

Think of the Healthcare.gov rollout as the Steiner attack, and it practically writes itself.

Pettifogger said...

As to doctors being forced to choose between retiring or collaborating with the government:

If things get bad enough, some doctors may take to hospital ships operating in international waters. To get care, you drive to a port city and pay for a helicopter ride to the ship. This obviously will not provide care to most people or be for most doctors, but perhaps enough will be able to afford it for it to be economically viable for a few doctors.

Smilin' Jack said...

Won't they be compelled to participate?

I'm sure we're all looking forward to being treated by a surgeon who was "compelled to participate."

BAM said...

Professor, I was one of those babies with a heart defect. I am quite thankful that the mechanisms were in place at the time to allow me to live, to sit in a few of your classrooms some ten years ago, and to now have a wife and child on the way. I pray that the changes brought upon by the ACA afford children in the future the same opportunity I had to live. Yet I take your comment to heart (pun somewhat intended) as I do not see any outcome other than rationing (to a greater extent than under private insurance), and a potential outcome of focus on "preventative" care as opposed to actual treatment.

chuck said...

Not to be a downer here, but the Soviet Union had a lot of female doctors because, IMHO, it was low status drudge work. We should see something similar happen here.

eric said...

As to looking at European nations and such to see if they have doctors shortages, why look there when we can look in our own back yard?

We do have 50 states to look at, don't we? And hasn't MA been called Obamacare, or hasn't Obamacare been called Romneycare?

Inga, how is MA doing on doctors since the implementation of Romneycare? Are there wait times and shortages?

Rocketeer said...
This comment has been removed by the author.
Rocketeer said...

I live in Massachusetts.

I haven't seen my doctor in years. But I see his NP an average of three times a year.

Before health care "reform," I saw him every time I went.

The problem? More people added to the rolls through "reform", with a shrinking PCP base. Doctors are leaving. Not just retiring,though that's happening, but actually leaving to set up shop elsewhere - at least until Obamacare made that unworkable, too. The waitlist for his practice - I actually should say his NP's pratice - is three years.

There are a whole hell of a lot of fully covered patients up here, with no doctor to see.

Mike said...

To answer Inga @ 11:47

Ours are BETTER than their pediatric heart surgeons because ours get a lot of practice. We routinely save babies that in the rest of the world aren't even counted as "live birth" because they are so hopelessly sick. My daughter is a NICU nurse who cares for these babies. Most would be dead within hours if not for the great advances in pediatric heart care developed here. In fact rich people the world over send their sick babies here to get their hearts fixed, when the little ones are able to travel to California.

I notice Sweden is not on your list. They used to be the go-to example of socialized medicine that "worked." But for the Swedes, around 2000 was when they began privatizing the public care and really improved it. They have their specialties too, of course, like IVF, but i don't know about pediatric cardiology there.

Michael said...

Inga. Why, then, do people with money from the countries you named come to the US for significant surgeries and consultation? Do the rich know less than the poor about their at-home medical choices?

C Stanley said...

How many sexually active women can be prevented from producing new babies for the cost of fixing one infant's heart?

Cripes, what a warped perspective. Screw the next generation, because their elders are incapable of refeaining from screwing. I hope the young women getting free birth control are havingfun while the blue babies gasp for their last breaths,

Inga said...

Massachsetts Medical Society poll indicates that 84% are generally satisfied with their healthcare.

Peter said...

"What is the likelihood that a baby with a defective heart will get it repaired? Is that the most efficient use of resources? How many overweight adults can be advised about nutrition and exercise for the price of fixing one baby? How many sexually active women can be prevented from producing new babies for the cost of fixing one infant's heart? These are questions that will need to be answered. How have they been answered in Germany... over the years?"

In the USA, the resources will be used to pay for questionable but costly therapies for autistic children.

Why? Because their parents (and in time the therapists) will have the most effective lobby. And when government's paying, who gets paid for what can only be decided politically.

Jane said...

Videochat medicine? I'd love to skype a doctor (doesn't have to be "my" doctor, doesn't even have to be a doctor) to ask basic questions that are usually along the lines of "do I need to come in or wait and see?" --

But no pediatric heart surgeons. My sister had open heart surgery in 1974, at age 6, for what's now an easily-fixable heart defect, but a generation prior would have been a death sentence.

Rocketeer said...

Inga, you dope, prior to healthcare reform in MA, the "satisfaction" rate was in the mid-nineties. It's been dropping since 2006! But your poll didn't mention the context, I noticed.

I also noticed this little gem from your press release:

"Seventy-eight (78) percent of Massachusetts adults believe that affordability is the single most important health care issue facing the state, according to the 2013 MMS Public Opinion Poll, released last month."

Which - again, in context - has actually risen since 2009. So much for "reform" addressing the affordability of care...

Sigivald said...

Won't they be compelled to participate?

How?

And even if so, well... good luck getting people to pay for med school (or even go through it on a subsidy).

Funny thing about prices and costs ... you can't actually get rid of them, and the more you distort them by trying, the worse off you are.

Inga said...

Rocketeer, you even bigger dope, people who were INSURED liked having access to healthcare I'M SURE. It ignores the uninsured, doesn't it? What was THEIR satisfaction rating?

gregq said...

So, Inga, just to be clear, we do have "epistimic closure" on the issue of "quality of doctors and people going to Med School", and you are the one with your fingers in your ears shouting "la la la, I can't HEAR you!"

Michael said...

Inga: the 84% satisfaction rate in Mass is interesting because the satisfaction rate nationally with individual's health insurance was 85% before Obama declared healthcare a national emergency.

Ann Althouse said...

I can see people are humor-impaired on this topic.

How much of a sarcasm-sledgehammer do I need?

You guys must be really unhappy.

Rocketeer said...
This comment has been removed by the author.
Rocketeer said...

Inga, you double dope, the surveys never were administered only to the insured; survey respondents included those without coverage. The uninsureds responses were factored in! I'd suggest you limit the scope of commentary to Wisconsin, in order to limit the subjects where you self-identify as an idiot.

Inga said...

Rocketeer, you triple dope (this is getting a bit childish, no?)

RomneyCare came into being because people were NOT happy with being UNINSURED.

El Pollo Raylan said...

RomneyCare came into being because people were NOT happy with being UNINSURED.

If that's literally true then dopes were duped.

Inga said...

And Rocketeer, you can site your OWN statistics all you want, doesn't mean they are accurate. Post a link to the satisfaction level of Massachusettes UNINSURED population before RomneyCare. Jackass.

david7134 said...

I used to teach at a medical school and can tell you that it would be best to get sick in the next few years before the new crop of doctors begins to practice. You will not like what is coming. The way that medicine is taught has changed substantially and most doctors are only being educated to the point to pass the boards, which are substantially dumbed down. I rarely saw a medical student that would read or do any extra work to improve their craft. Then you have the limited hours during residency. This really cuts into their ability to learn. We had to be in the hospital 25 hours a day and saw everything you could imagine. You did not sleep, but that is where you learned your limitations. We did not have errors as a result to long hours. But, in the end, medical care as you know it is over. The British hate their system, but we can't learn by others experiences.

eric said...

"I can see people are humor-impaired on this topic.

How much of a sarcasm-sledgehammer do I need?

You guys must be really unhappy."

Hey, don't blame me, I tried to help.

Or does Affordable Lawyer Care make you unhappy?

Inga said...

So, why did y'all like Romney so much and wanted him to be your President?

eric said...

Inga wrote;

"RomneyCare came into being because people were NOT happy with being UNINSURED."

So many people were unhappy about not being insured, that they went to the polls in droves in 2010 to kick out their representataives and changed the makeup of the House of Reps in the United States.

And I predict that in November of 2014, that there are going to be a lot of people who are very unhappy about being forced to be insured (Hey, dummies, the Democrats know what's best for you!).

It's so good, we have to make you take your medicine!

And yet, even if this does happen, Inga will come and tell us why the Republicans won.

Shall we start the excuse pool now?

Koch's Fault
Racist Voter ID laws
Voter Suppression
Gerrymandering

What am I missing?

The Drill SGT said...

Inga said...
So, why did y'all like Romney so much and wanted him to be your President?


compared to the alternative?

Inga said...

Eric,

I'm not sorry to say that 2014 will not be a good year for Republicans. The Shutdown/ Default fiasco still sits squarely on their shoulders. And it won't be forgotten. How are Republicans doing in the polls? How many seats up up for grabs in the House?

El Pollo Raylan said...

Inga's mantra is always the same: Republican's suck; they need to become more like Dems; they suffer from epistemic closure (yes, her words).

She's a sullivanist and she doesn't even know it.

Inga said...

Listen to Krauthammer emphasizing "mainstream" conservatism on the Jon Stewert interview Althouse has a post on above. Very interesting.

jr565 said...

I have a relative who used to be a republican, but is now whole hog pro Obama, and we had a discussion about healthcare, and in particular about Medicare. My doctor, who basically deals with Medicare patients tells me how he is reimbursed so little from Medicare that its impacting the number of patients he sees. And he says many other doctors he knows are not taking any Medicare patients at all.
I mentioned this to her and she basically made the argument that doctors need to accept less in reimbursement.

The whole concept of having a system that is based on mathematics seems to go over her head. When it comes to the govt programs she had a blind spot to the actual ramifications of said programs.

Do doctors not have to pay rent? are they supposed to go into debt so as to cover patients when govt isn't going to reimburse them for their services? Is the landlord going to lower the rent? Are the drug companies going to lower the price of medicine?

And one of the outcomes that seems to be happening now is that far more people are being shuttled into Medicare than are buying insurance which undermines the whole math behind Obamacare in the first place.

But as my doctor said, if more people are going to go on Medicare, its going to mean that fewer doctors will be seeing them.

You can't even argue that these are unforeseen consequences, since critics of the bill have been making the cost arguments since day one. But, dems and libs will always have that blind spot for fairness, versus the reality of delivering fairness. It will turn out that this will not be fair, will not lead to lower costs and will result in all manner of bad stuff occuring.

And the libs will NEVER acknowledge they are wrong. The buck never stops with them.

eric said...

Inga wrote:

"I'm not sorry to say that 2014 will not be a good year for Republicans. The Shutdown/ Default fiasco still sits squarely on their shoulders. And it won't be forgotten."

Inga, I'm sure this is 100% true.

Which is why I'm trying to get an over/under on the excuses when the Republicans win in 2014.

Vote Fraud? Or intimidation? Koch brothers?

All of the above?


"
How are Republicans doing in the polls? How many seats up up for grabs in the House?"

Well, according to the Cook Political Report, there are only 12 total seats that are "Toss Up" the rest are either "lean Democrat" or "lean Republican" or "Solid Democrat" or "Solid Republican" or even better for the parties.

Of those 12 seats that are "Toss up" 2 belong to Republicans and 10 belong to Democrats.

So what's the excuse when Democrats lose?

B said...

Inga wrote; "RomneyCare came into being because people were NOT happy with being UNINSURED."

You don't know what the hell you are talking about.

The uninsured in MA, especially young people needing no more than the occasional emergency room visit - were quite happy being uninsured. They got free care at any hospital by law and still do. Hospitals charged a premium above insurance coverage to the insured to cover their losses.

Romneycare passed into law because the insured and the health care industry were not happy subsidizing the uninsured who were quite capable of carrying coverage. If you do not have health insurance in MA now you either join an exchange where you pay for coverage at a rate depending on your income or pay a tax penalty when you file. Since the tax penalty is much less than any insurance rate out there including the exchanges young people inclined to throw the dice on staying healthy simply pay the tax penalty. For them nothing has changed. They get emergency rooms charges sent to them and everyone of them knows that they can settle the charge for much less than the bottom line. The hospital is happy to get anything.

So hospitals still charge the insured an out of pocket premium above what their agreed upon treatment rates with insurance coverages are they accept to cover their losses.

And don't even try to tell me different as I am intimately and personally familiar with the results of Romneycare. Nothing has changed but the addition of a bureaucracy siphoning off their own slice of the pie and higher rates for the insured.

jr565 said...

Inga, please.
Obamacare is dead on arrival, and will be driving up everyone's health care costs. Even people who didnt buy health insurance through the exchanges. What's more important to people, a temporary partial govt shut down (that had 85% of govt running and which paid all the workers back who weren't working for 15 days) or the fact that people's health I durance premiums just went up, or they lost their insurance and now have to go searching for a more expensive plan on a website that doesn't work.

Many dems are now asking for the same delay that libs were vilifying repubs for. Because this bill is SO toxic.

And, Inga, its only going to get worse, not better.
So, lets look at elections in that light.

Beleive me, people aren't going to care that govt was shutdown for two weeks. If anything, Ted Cruz will be even more popular for trying to stop it before it hit everyone in the pocket book.

jr565 said...

Ing awrote:

So, why did y'all like Romney so much and wanted him to be your President?

when the choice was republican squish versus Mr. BIGGEST govt. the choice was pretty clear (except maybe to libertarians). And for all the flaws of Romneycare, les not forget that Romneycare was a local program, which falls under federalism, and not a one size fits all program, run by the Feds for all the states.
What might work in MA will not necessarily work EVERYWHERE at once.

Birches said...

It seems silly to drop in and give my two cents now that the trolling has started, but I've got a friend in his 3rd year of residency. The entire time he was in school he planned on being a Primary Care doctor. Now looking to get into sports medicine. Why? You already know the answer.

Rocketeer said...

You know what what's childish, Inga? Asserting you know what the hell you're talking about, when you clearly don't know what the hell you're talking about. It's only made worse when you look away from information that refutes your dug-in position. Epistemic closure, indeed. You're obviously capable of doing you're own research - you found the MMA press release. It's also obvious that you cherry-picked, because when you googled that and posted, you overlooked dozens of other hits that put it in context.

El Pollo Raylan said...

Inga said...
I think we have seen an epistemic closure here. Not much more to be said. They will believe what they want and continue to disregard statistics based in reality.

I think I'm seeing a peristaltic closure. That is when the colonic muscles clamp and cramp so hard that passage is blocked and backs up.

marvin said...

MCAT scores are given out on a curve, top X% get a 15, next Y% get a 14, and so on on down. The %'s change between the three tests. So if the number of acceptances is going up, AND the average scores of those accepted is going up, either the company giving out the scores is making the scoring easier, or there are a lot more people taking the MCAT, or there were a lot of people who take both the MCAT and the LSAT, and the high scorers are deciding to go to Med School rather than law school because of the law school implosion.

There are alot more people taking the MCAT. ~ 54k in 2001 and ~ 89k in 2012. As other high-paying careers continue to falter (high finance, law, engineering), the growth rate in the medicine industry makes the prospect of being a doctor increasingly more attractive.

There is absolutely nothing you can determine about the quality of the matriculantes based on that information, because MCAT scores are relative numbers not absolute numbers, so you can not meaningfully compare them from year to year (unlike the SAT, for example).

AS for the GPA numbers, what were their fields of study? A 4.0 in English means something very different than a 4.0 in Physics. Thrown in with the ongoing grade inflation, again, the number sound pretty, by prove nothing.


The number of applicants is up 30%. The number of matriculants is only up 20% over the same time period. Read: Medical schools are getting increasingly selective over time. Every year, the fraction of total applicants granted admission goes down. Unless the quality of the applicant pool has significantly fallen (an assertion that would require significant proof), matriculants are at least as smart as they've ever been. In any case, it's a far cry from "smart young doctors are hard to find!".

But if they're just going to Med School because they think that's where they're going to make the most money, rather than because they desperately love medicine, then all you all "there's no problem" people are going to be very upset in 10 years.

So what if their motivations are different. Those motivated primarily by income gotta keep working if they're going to make that income. Path dependence is a bit of an issue in a field where people burn 7+ of the most productive years of their lives and rack up hundreds of thousands of dollars in loans before they even start working...

Note that you'll also find plenty of doctors that "desperately love medicine" when they started but quit when they got to the "medicine is bullshit now!" phase of their lives. In fact, they write an awful lot of articles like this one.

cubanbob said...


Different sort of doom. Medicaid patients suck because the pay is poor and they drive paying insurance patients from your waiting rooms. Unless you're desperate to build a patient base, you don't take them. And really, not relevant to this discussion.
10/25/13, 11:49 AM

Not relevant to the discussion? Why do you think the ACA was passed if not as an additional subsidy for Medicaid and Medicare?
Besides the only way over time the insurance companies can survive is to further squeeze the providers while the providers try to jack up the billings to the private insured to covers their losses on the public sector patients. So what are you going to do when your choices wait until whenever for the doctor who takes Obamacare sees you or get seen right away by a fee for service doctor? As for the miniscule percentage of foreign doctors, since Obamacare is supposed to bring in another 30? 40? million more people in to health insurance market so where are the extra doctors now to see those people? Looks like we are going to need those foreign doctors as well.

Archie said...

It's already started in California. Under a new law signed by Jerry Brown women can get abortions from their hairdresser, the barrista at Starbucks, the pharmacy clerk at Walgreens and from their manicurist. This is what happens when doctors decline to engage themselves in certain procedures and practices.

Almost Ali said...

Exhausting, and futile.

Besides, it's the law of land. And just because my primary (MD) went back to Venezuela, and my new, younger primary just quit his practice to work in the hospital (reliable income) - it's anecdotal.

cubanbob said...

7 years ago, the University of Wisconsin School of Medicine and Public Health added a rural, underserved program of 25 to it's existing 150 member class. These applicants are under the same requirements for admission, with additional screening to try to ensure their return to rural/underserved Wisconsin. Also, the Medical College of Wisconsin has plans for expanding their teaching presence into rural Wisconsin.

These two programs plus UWSMPH's urban, underserved program will no doubt be dealing with high numbers of Medicaid recipients. "

That's nice mrs e. Do tell us how much of a discount those students received in order to induce them. And for how long a period of time.

In other news a WI institute has calculated that for the average WI private individual insured that doesn't qualify for subsidies their premiums will largely double under Obamacare. Let Inga know so she will be more respectful of the poor WI policy holders who will be subsidizing her. Medicaid isn't cheap and the policy holders will be paying extra to help keep the state funded portion of Medicaid afloat.

Marshal said...

Archie said...
Under a new law signed by Jerry Brown women can get abortions from their hairdresser


Perhaps this is slightly overstated but it is interesting to consider how these measures to save abortion at all costs are going to effect licensing and other regulations. If you don't have to be within 30 miles of a hospital or under the care of a licensed physician for an invasive procedure like an abortion how can those requirements be enforced for a cyst removal?

The left is proving to everyone their "regulation" framework is entirely driven by the desire for business control rather than patient safety.

Inga said...

Cubanbob, I will get absolutely NO subsidy.

ALP said...

Google the term: "New face of Medicaid"

I will be on Medicaid in WA state come Jan 1. This is after decades of being gainfully employed until my layoff, and purchasing my own individual plan for the last few years. Having heard terrible things about it over the years - it does not sit well with me; I never dreamed in a million years I'd be on what I consider to be "welfare".

Curious, I Googled the term above. Apparently, I am not the only one curious about how the influx of newer Medicaid patients is going change the system. Several studies have been done in an attempt to answer this question. What I found surprised me, and made me even more curious.

To summarize quickly: the newer Medicaid members will be younger and a little healthier - less obesity and chronic issues such as diabetes. My quick read seems to find it will improve the system...I can't be the only "formerly gainfully employed; tossed aside by the economy; reasonably healthy person" joining the Medicaid system. Since folks like me have HAVE little choice but to accept Medicaid (the alternative being to continue to buy individual with a 35% increase, thus forcing one to stretch diminishing resources until the next job...)it would seem that this system may be the one getting the healthier, new members.

Inga said...

Hey ALP, maybe Cubanbob will tell you to mow his lawn, as he did to me a few days ago, when he thought I'd be getting a subsidy, or be eligable for Medicaid, which I AM NOT. No subsidy, no Medicaid.

Inga said...

Oh, and another comment/ question directed to ALP as a younger person. Would you rather go to the ER for medical care (as B indicates young people in Massachusetts preferred) or would you rather have health insurance or Medicaid?

e9a47e7c-3dd1-11e3-a7bf-000bcdcb8a73 said...

"and GPAs are up ~ .8-.9 points for applicants." Really. Are you saying that in 2001 the average GPA for a med student was 3.1-3.2. That doesn't sound even close.

ALP said...

Inga: HA - Cuban Bob is unaware that my partner won't let me NEAR the lawn mower - so bring it on!

As to the second question (don't know if 52 yrs old makes me a "young person" to the medical profession): I'd rather have health insurance purchased with my own earnings - separate from my employer. The one good thing about what is happening is health care is being severed from employment. I never liked having my employer involved in my health care AT ALL - even to provide insurance. My #1 preference: A fucking job so I can buy my own insurance.

At 52, my attraction to risk is minimal. Acceptance of higher risk is the territory of the young. Using the ER sounds too risky to me.

Inga said...

Thanks for replying ALP, I thought you were younger, not that 52 is old. I'm 61, ancient.

Michael said...

Inga. If you have, as you say, cheaper insurance under the new plan you are indeed being subsidized by the people whose premiums are going up. Math.

ALP said...

Inga: some of my best friends are your age. The only difference, really, is whether the Beatles made a huge impression on you or not.

heyboom said...

I think we have seen an epistemic closure here. Not much more to be said. They will believe what they want and continue to disregard statistics based in reality.

My goodness, Inga! You've pretty much described exactly what you yourself do on every issue! You even did it here on this thread:

And Rocketeer, you can site your OWN statistics all you want, doesn't mean they are accurate.

You are the queen of selective reality and fact acceptance.

heyboom said...

Not one single doctor that my wife works with supports ACA. Not one.

Inga said...

I don't know how much these docs love the ACA, but they sure do like Medicare for All

SOJO said...

The Canadian bypass doctors who did my bil's unforeseen emergency quadruple bypass in were great. Maybe we'll also eventually get a different kind of doctor - less asshole prima donnas.

I know of several world class doctors who takes medical at excellent hospitals. When you get to a certain level of need, you are pretty much serving people who have that extreme need where only a few are doctors are available and it is obnoxious to turn people away. You have plenty of other people with that specific need who have regular insurance to equalize things. IOW I've seen altruism at the highest levels.

OTOH, I also know of a meh general practice doctor that started charging his over-65 patients $1000 a year to do their paperwork for medicaid BEFORE Obamacare, so there you are.


Single payer is preferable for MANY reasons one of which is the pricing. A bypass here would have cost $400K - in Canada it cost $50K. Heck, someone could actually pay for that even without insurance and without bankruptcy.







heyboom said...

That partisan press release you linked comprises more than just doctors. It includes medical students and other health professionals. So it doesn't exactly make your point. I'll also add the private practice internist my daughter works for is also dead against ACA.

Herb Nowell said...

We got by without pediatric heart surgery before 1956. I'm picturing lots of nurses and lots of palliative care.

You could change the first sentence to "We got by without for most of human history". The lots of nurses you mention are arguably less than 175 years old as a profession with Florence Nightengale starting the modern profession in the Crimena War.

So, yes, we got by without for most of human history and certainly for all but a sliver of human existance. However, that's a far cry from, "if you like your doctor you can keep him" and even what has been considered modern medicine for your lifespan.

If Obamacare is going to move use to pre-1956 medicine (or pre-1986 or 1896 or whatever) then people need to honestly explain that and why it's a good thing

Largo said...

I can see people are humor-impaired on this topic. / How much of a sarcasm-sledgehammer do I need? / You guys must be really unhappy.

I still love you, Ann.

"... over the years?"

And I remain in awe!

Jupiter said...

"Won't they be compelled to participate?"

That's what I want. A surgeon who is "compelled to participate" in whacking me open. Cut-rate, as it were.

gregq said...

marvin said...
There are alot more people taking the MCAT. ~ 54k in 2001 and ~ 89k in 2012. As other high-paying careers continue to falter (high finance, law, engineering), the growth rate in the medicine industry makes the prospect of being a doctor increasingly more attractive.

Yes, that's right, there are a lot more people taking the MCATs. When 30% more take the MCAT, that means 30% more will get a 15 on the Biology test.... It does nto matter hwo good or bad those test takers are, the MCATs are graded on a curve. More test takers means more people with higher scores.

Me >>>
There is absolutely nothing you can determine about the quality of the matriculantes based on that information, because MCAT scores are relative numbers not absolute numbers, so you can not meaningfully compare them from year to year (unlike the SAT, for example).

AS for the GPA numbers, what were their fields of study? A 4.0 in English means something very different than a 4.0 in Physics. Thrown in with the ongoing grade inflation, again, the number sound pretty, by prove nothing.
<<<
Marvin >>>
The number of applicants is up 30%. The number of matriculants is only up 20% over the same time period. Read: Medical schools are getting increasingly selective over time. Every year, the fraction of total applicants granted admission goes down. Unless the quality of the applicant pool has significantly fallen (an assertion that would require significant proof), matriculants are at least as smart as they've ever been. In any case, it's a far cry from "smart young doctors are hard to find!".
<<<

Actually, growing their class sizes by 20% sounds like they're growing as fast as they can (takes tiem to build more classrooms, hire more staff, etc.)

You've got 30% more applicants than in the past. If your previous applicants already included all the "top people", then by definition increasing the applicant pool decreses the quality of the pool.

In short, you've not provided the slightest bit of evidence that actually supports your claims.

Marvin>>>
So what if their motivations are different. Those motivated primarily by income gotta keep working if they're going to make that income. Path dependence is a bit of an issue in a field where people burn 7+ of the most productive years of their lives and rack up hundreds of thousands of dollars in loans before they even start working...
<<<

Ah, Marvin, the man who's perfectly happy if his doctor sees him as an entry in the doctor's check book, rather than a person the doctor wants to help.

new source said...

I don't think they can be compelled to work if they choose to retire from the practice.
This is the perspective of a doctor who believes his profession is highly deserves to be treated that way but I think he is a little blind about the continuing ability of doctors to opt out of the system. Won't they be compelled to participate? I don't think they can be compelled to work if they choose to retire from the practice.

Medical Group Purchasing Organization