February 24, 2014

The handsome doctor laughs at (other people's) death and runs for office.

Do we really want doctors representing us in Congress?

I'm linking to The Daily Mail's coverage of this story because it's got some nice pictures showing the physical attractiveness of the physician Milton Wolf and his family and in spite of the British paper's inability to write clearly about whether this man is running for the Kansas state senate or the U.S. Senate. (It's the latter, but DM repeatedly writes "Kansas Senate.")

Where do we get this idea that a background in medicine is particularly apt for lawmakers? How many doctors are there in Congress anyway?
2012 was again a landmark election in terms of physician candidates, with 50 physicians running as challengers or in open seats for federal office at one point during the cycle.  The 113th Congress will welcome two new physicians to the House of Representatives.

Twenty physicians are currently serving in the 113th Congress which include three senators, 16 representatives and one delegate. Seven of these members of Congress are graduates of AMPAC’s Candidate Workshop and/or Campaign School.
I know some people are leaning toward assisting Wolf — here's Instapundit — but why empathize with a man who flaunts his lack of empathy? Here's the direction I lean: What is going on with this promotion of doctors in the American political scene? There's something odd and excessive about our respect for them. We must trust and depend on them when we have medical problems, but why are we bent on installing them in political office? Let's think more carefully about the sort of minds that go into medicine and whether we are not overvaluing them as political candidates.

239 comments:

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surfed said...

Don't go to the first link - Daily Mail. After a few seconds up pops a "V Alert" telling you that there are viruses on your computer. Not difficult to make go away but you have to think about how to do it for a second. Forewarned is forearmed.

Pookie Number 2 said...

Let's think more carefully about the sort of minds go into medicine and whether we are not overvaluing them as political candidates.

On an absolute basis, we're probably overvaluing the value of doctors as political candidates.

On the other hand, the typical doctor looks really good relative to the typical career politician who is hungry for power and sadly bereft of real-world experience, practical knowledge, and common sense.

ddh said...

Lawyers are also given unwarranted respect in politics and are overrepresented in our legislatures. It's not as if they write wiser or better crafted laws.

Ann Althouse said...

"Lawyers are also given unwarranted respect in politics and are overrepresented in our legislatures. It's not as if they write wiser or better crafted laws."

People know to mistrust lawyers. Lawyers are not overvalued.

And lawyers are at least people who have studied law and legal problems. That's part of why we mistrust them.

But there is the awe of and deference toward doctors that I think we should become aware of.

Heather said...

I know too many doctors and nurses to get bend out of shape at gallows humor.

I'm just tired of old deleted things only getting used against conservatives.

Christy said...

Doctors use logic in their everyday lives. They look for the truth in a situation and most of us believe politicians and lawyers, but I repeat myself, look for what they can convince a group of citizens with more sensibility than sense is the truth.

Anyhow, didn't we all love the doctors of M*A*S*H who laughed in the face of death? Wasn't Alan Alda the face of the new sensitive man we all wanted?

Empathy is overrated in politicians. Alas, those of us who want a leader not a new boyfriend are generally out-voted.

DW Budd said...

I think you're reading more into DDH's point than is there. He didn't ask if we as a society have overvalued lawyers generally. He asked if they are not given unwarrented respect "in politics" or if they are "over-represented in our legislatures."

His response is more to the question(s) you directly posited, namely:

Where do we get this idea that a background in medicine is particularly apt for lawmakers? How many doctors are there in Congress anyway?

plus your comment:

Let's think more carefully about the sort of minds go into medicine and whether we are not overvaluing them as political candidates.

I think it is safe to ask, if we compare the number of doctors in political office versus the number of lawyers, you may answer your own question.

Personally, I think that to be a medical doctor requires a certain amount of practical intelligence and common sense, rather than an ability to finagle, cajole, and distort information as an advocate, the very definition of a lawyer.

Ann Althouse said...

"I know too many doctors and nurses to get bend out of shape at gallows humor."

Yes, exactly. That's my point!

ddh said...

Medical education teaches doctors to view the body as a system so that it can be treated for disease and injury. Too much empathy would interfere with treatment, which sometimes requires doctors to ignore the pain they must inflict. The problem with empathy is that doctors need to turn it off to cure the disease or injury and on to treat the patient.

Among medical specialties, radiology interprets x-rays, cat scans, and other images of the body, often without the doctor even meeting the patient. It is ironic that doctors who are bothered by inflicting necessary pain sometimes go into radiology, where they don't even see the living patient. They concentrate on imaging the problem so that it can be cured, not treating the patient.

BDNYC said...

Supposedly there's a difference between surgeons, who tend to be highly confident and like to have the ball in their hands, and diagnosticians, who tend to be more reserved, skeptical and less decisive. Something like that.

Who the hell knows.

Ann Althouse said...

"Personally, I think that to be a medical doctor requires a certain amount of practical intelligence and common sense, rather than an ability to finagle, cajole, and distort information as an advocate, the very definition of a lawyer."

My point is that we are overvaluing doctors in politics and that our physical need for them distorts our thinking about them and power-seekers are leveraging this distorted thinking.

With any given electoral choice, the voter is challenged to pick the better candidate. I'm not saying lawyers are better than doctors. I'm saying that we need to work on our assessment skills which seem to be off when it comes to doctors.

Wolf displays some particular problems that may tend to exist in the minds of doctors. Choosing a representative, you are choosing a mind to think about policy for you. The mind of the doctor is not as generically good as you might think.

dmoelling said...

Why not Doctors? At least they are not professional politicians. I'd rather live with a few gaffes. We have Lawyers (and doctors) in congress because they are one of the few occupations that can interrupt their career at minimum cost to run for office. Since medical issues are such a large part of the economy why not have at least 50? Ditto for ex-military, business guys, farmers etc.

ddh said...

The problem with lawyers in politics is that they tend to think that writing a law or regulation is the solution for almost all social problems. Unintended consequences don't figure heavily enough in their thinking.

MayBee said...

For the most part, we don't want the type of people who run for office to be representing us in congress.

Pogo is Dead said...

"...why empathize with a man who flaunts his lack of empathy?"

Better to be like Obama, and fake empathy.

The plethora of MDs running for office arose only because of Obamacare.

No one asked MDs about it, they just voted for a monstrosity without reading it. Most of them lawyers, a good number were teachers (an even stupider group).

Hell, WF Buckley was right: "I'd rather entrust the government of the United States to the first 400 people listed in the Boston telephone directory than to the faculty of Harvard University."

But that's not who's running.

Pogo is Dead said...

"...we are overvaluing doctors in politics and that our physical need for them distorts our thinking"

So what?
Hell, Minnesota elected an actual comedian.

here's Al on Letterman:
"Al Franken: “Right. So they wanted to smear the guy who came back with the report, and so they out his wife and said she sent him there. This is essentially, you know, George H.W. Bush, the President's father, was the head of the CIA and he has said that outing a CIA agent is treason.”

Letterman: “It is treason, yes.”

Franken: “And so basically, what it looks like is going to happen is that Libby and Karl Rove are going to be executed."

Letterman, in mock indignation: “What? What! Really?”

Franken cautioned: “Yeah. And I don't know how I feel about it because I'm basically against the death penalty, but they are going to be executed it looks like.
"

Guffaw!

Sean Gleeson said...

Historically, physicians have been respected members of society. Their calling is a noble one, and they take a sacred oath to behave ethically. Their appeal could cross partisan lines, because they are seen as acting impartially for the good of all mankind. It's really no surprise that they would be able to win elections.

But just recently, I mean since 2009, government and health care have become one and the same Leviathan organization. Now anyone who cares about his health care must engage in political activity to influence it. Even conservatives, who wish to repeal Obamacare, can see the usefulness of nominating a doctor, who can debate the issue with more authority than a layman.

NotquiteunBuckley said...

Krauthammer, when asked "how do I become a syndicated columnist," replied "get your MD."

So, it's Charles fault. All of it.

Pogo is Dead said...

The US education system distorted our thinking about US history, economics, morality, and culture.

Yet we repeatedly elect teachers.

Get it straight: the government doesn't love you. It doesn't care about you. It can't.

It sees some of us as milch cows, all the rest are just more mouths to feed.

Have you ever been around grade school teachers talking about their students at a party?

Do you really think Congress are any less unfeeling about their constituents behind closed doors than lawyers, teachers or doctors?



Ralph Hyatt said...

"But there is the awe of and deference toward doctors that I think we should become aware of."

Awe and deference? I honestly can't think of anyone I know that has that attitude towards doctors.

Is the idea that people are awed by doctors common among lawyers?

Ann Althouse said...

"Don't go to the first link - Daily Mail. After a few seconds up pops a "V Alert" telling you that there are viruses on your computer."

Daily Mail is the most popular news site on the entire web. I'm not seeing anything wrong with it (other than general trashiness).

Hagar said...

Isn't that blanket discriminatory or something?

Helenhightops said...

There are many jerks in medicine. This guy showed terrible judgment. He is probably a jerk.

But I don't see why you would be excessively worried about having a doctor or a nurse represent you. They are trained decision makers in one of the helping professions, have to take responsibility for their decisions, and their work brings them into contact with people from all walks of life. They are working where the rubber meets the road.

Clyde said...

Many of America's pathologies can be laid squarely at the feet of our permanent political class in Congress, most of whom serve for decades in gerrymandered districts and won't leave their cozy Washington sinecures unless they do something so egregious that that have to resign. Most of them are lawyers.

I'm of two minds abut this. On the one hand, it would be good to just give the toilet a good flush (or more -- some of them are definitely four-flushers) and get rid of the whole damn lot of them, and bring in a completely new, fresh set of representatives and set term limits on them. Put an end to career politicians who spend decades in Washington, luxuriating in decadence of our imperial capital.

On the other hand, that wouldn't solve the concomitant problem of the rest of the permanent Washington establishment -- the lobbyists and other assorted corrupt hangers-on -- who simply would eat the lunch of the naïve, inexperienced new representatives.

It would be nice to have people who are familiar with the law, but since most of the lawyers currently in Congress don't even read the mammoth tomes they send forward, like Obamacare, it seems that is less than a prerequisite than one would think.

The best thing we could do is ask the British to come back and burn the place to the ground again.

Pogo is Dead said...

If I had done that FB page, I'd have been fired. And for good reason.

Should poor judgement like that get elected to Congress?

50 years ago? Hell no.

Today? Hell, he's the least of our worries.



The Crack Emcee said...

"Why empathize with a man who flaunts his lack of empathy?"

What did jr565 tell me yesterday? Blacks should "accept the cards you were dealt"? Of course, if we did that, slavery would STILL be going on. Insty likes him, too - that matters.

"Why empathize with a man who flaunts his lack of empathy?" You're asking this of the people who kept blacks down for 400 years?

Surely you jest,...

Ann Althouse said...

"Better to be like Obama, and fake empathy."

If you don't even know you should fake a little empathy when you have none, you're failing even at the sociopath game.

Matthew Sablan said...

[Obligatory lawyer joke.]

James said...

Cue the faux outrage machine!!!

Just last week it was almost worn out out over the Wisconsin National Guard honor guard clowning around an empty casket.

Both incidents are much ado about nothing.

AReasonableMan said...

A majority of physicians support the ACA, so they have that going for them. On the other hand there is Michael K. It's a tough call.

Freder Frederson said...

Lawyers are not overvalued.

Maybe not by non-lawyers, but among themselves they certainly think they are more valuable to society and think themselves more brilliant than they actually are.

James said...

A majority of physicians support the ACA

How about some proof of that claim?

Pogo is Dead said...

Depends on your targets.

Sure, empathy worked for Obama, the BTK killer (Dennis Rader), and Ted Bundy.
Targets: generally women, some beta males.

But brazen cold sociopathy targets men and women. That's where real power arises, the kind where you can kill millions.

Hell, dysempathy can get you your own t-shirt, even if you fail.

Brennan said...

Ann: We not only trust Doctors for their expertise in medicine. Doctors are also some of the most successful entreprenuers in the United States. They are also operators of small businesses. They are keenly aware of the balance of regulation and the marketplace.

Brennan said...

People know to mistrust lawyers. Lawyers are not overvalued.

Polls show that the younger you are the more you trust lawyers. It should come as no shock of the naivete of young people.

The Crack Emcee said...

"brazen cold sociopathy targets men and women. That's where real power arises, the kind where you can kill millions."


It's just hanging there,…must,…resist,….

Larry J said...

Do we really want doctors representing us in Congress?

Perhaps if we had more doctors in Congress, the Obamacare legislation wouldn't be such a mess. We need more people with real world experiece (doctors, teachers, business owners, etc.) in legislatures. Instead, we get a bunch of dumb ass lawyers who think they know everything about everything. I'm not saying that no lawyers should be in legislatures and Congress, but the percentage should be a lot less than it is now. The percentage of lawyers we have now hardly constitutes representative government.

PB Reader said...

We've got waaay too many lawyers already. They should be hired, as necessary, not put in charge of all decision-making.

Ignorance is Bliss said...

The government could sure as hell use more people with an attitude of First, do no harm.

A wise woman once said 'Better than nothing' is a high standard. Same idea.


April Apple said...

Office holders representing the American people were to be from all walks of life. Shouldn't the greater outrage be that a very high percentage of all democrats never held an actual job, never created an actual job, and never had to work a day in their life? Oh and these same democrats are now wealthy because of their political/lobbyist connections...
and are often for-life career politicians.

April Apple said...

Everyone knows a majority of doctors detest and despise the ACA. The insurance companies all stand to profit.

So much for that.

Scott said...

"...in spite of the British paper's inability to write clearly about whether this man is running for the Kansas state senate or the U.S. Senate. (It's the latter, but DM repeatedly writes 'Kansas Senate.')"

British writers write differently from American writers. Another candidate for the "overwrought" tag.

Big Mike said...

Where do we get this idea that a background in medicine is particularly apt for lawmakers?

@Althouse, where do you get the idea that law is an apt background for lawmakers? Is there anything about the current US Code that suggests to you that the law as it stands today is about anything other than increasing the demand for lawyers and making them more wealthy?

And, answering your question, ever since the US government took over our healthcare system it has become critically important to get people into office who understand the realities of healthcare delivery.

Birkel said...

"Too much empathy would interfere with treatment, which sometimes requires doctors to ignore the pain they must inflict."
--ddh above @ 6:38am


The good professor skips right over this important point because it doesn't fit her goal. Example: Paul Volcker had to choose between higher inflation or continued stagflation and he chose to tighten the money supply and suffer the higher inflation because it was the less dangerous thing even though painful.

Lawyers, trained as we are, who enter politics promise everybody who will listen that there is a free lunch somewhere at the end of the rainbow. Because we're trained to think laws, lawyers, judges and et cetera can be helpful without imposing costs. We talk about sliding scales as if they're not blunt instruments but can be precisely tuned to fit exactly our purposes.

It is a lie.

Althouse's comment is sophomoric because it doesn't admit why Wolf's humor causes her discomfort. Oooh, that comment made me sad so maybe doctors, as a group, should be more critically examined when running for office. Also, ignore all the positive interactions you -- dear readers -- have had with doctors and all the bad ones you've had with lawyers. Don't let that inform your opinion.

Scott said...

If you want to piss off a Brit, just characterize their spelling or usage as "idiosyncratic."

Michael said...

Doctors are in the cure business whereas lawyers know that a cure is death to their profession. Lawyers think it natural to make laws. Doctors to do no harm.

carrie said...

My brother is a doctor and I agree that doctors make poor leaders in government. Their views of the world are skewed, in my opinion, and not a in a good way. But their stature as doctors makes them think that they are infallible and it is impossible to have a balanced discussion with them about anything. I hope that Obamacare has been a wake up call for them, but I bet they won't admit it.

carrie said...

My brother is a doctor and I agree that doctors make poor leaders in government. Their views of the world are skewed, in my opinion, and not a in a good way. But their stature as doctors makes them think that they are infallible and it is impossible to have a balanced discussion with them about anything. I hope that Obamacare has been a wake up call for them, but I bet they won't admit it.

Illuninati said...
This comment has been removed by the author.
Bruce Hayden said...

Maybe not by non-lawyers, but among themselves they certainly think they are more valuable to society and think themselves more brilliant than they actually are.

I grew up with lawyers. My father was one for almost 50 years, and a lot of his friends were also lawyers and judges. So, no surprise that several in my generation are lawyers too, including, sometimes unfortunately for everyone else, yours truly.

But, I think that a law degree should disqualify you from running for political office, and esp. at the national level. Last I knew, a majority of Congress had law degrees (not calling them all lawyer, because there are always some who get the law degree just to go into politics - e.g. Ted Kennedy), plus apparently the bulk of the lobbyists in DC are legally trained (the only place I know of in the country where lawyers can share fees with non-lawyers). Wonder why the PPACA (ObamaCare) or Dodd-Frank are 2,000+ pages long? Wonder why there are thousands of statutes that you can criminally violate any more? Why pretty much everyone, without a lot of professional help, screws up their tax filing with the IRS? It is all the lawyers. Fewer lawyers in and around the government at the top would probably result in a much more understandable body of law that we have to live under.

Why are lawyers so bad this way? Because this is what they enjoy and do for a living. There is some evidence that the smarter you are, the more you understand and enjoy complexity. And, indeed, the former is maybe one of the best explanations for intelligence. Attorneys, as with physicians and thos with PhDs, have IQs that are, on average, about one standard deviation above the mean (according the "The Bell Curve"). Physicians tend to apply their love and ability with complexity to the human body and dealing with sickness to such. Attorneys, by training, apply it to the spoken and written word, which is why our laws are now so voluminous and complex. You have a small (in terms of all the attorneys in the country) group writing the laws, and then a much larger group advising people how to comply with, or get around the laws that the first group drafted. Great for the lawyers. Not so great for everyone else.

It seems that the Republicans tend to have a physician or two in the Senate, and they tend to be outstanding Senators. Much higher quality, in my view, than the typical lawyer in Congress.

Freder Frederson said...

Everyone knows a majority of doctors detest and despise the ACA.

How about some proof of that claim?

Unknown said...

Emcee -- 2/24/14, 7:33 AM -- are you saying blacks freed themselves? Do you know any history at all?

Illuninati said...

Althouse said:
" Let's think more carefully about the sort of minds go into medicine and whether we are not overvaluing them as political candidates."

What a shame. All those doctors are taking valuable political positions which could be filled by lawyers. More seriously, Obamacare has already done so much damage and will do so much in the future that we need some medical care professionals who actually understand medicine to fix the mess.

Milton Wolf is a radiologist. Depending on his subspecialty he may read pictures all day with minimal contact with actual patients. Because radiologists see so many gruesome things on a daily basis they have to develop a psychological barrier to protect them from the recurring tragedy. He may be a sociopath who lacks empathy for other people or he may be someone who has blocked out the reality that there are real people behind those pictures. In any case, considering the privacy laws, it is surprising that he is displaying those pictures.

tim maguire said...

We have an unfortunate habit of thinking that because someone is accomplished at one thing, they must be accomplished at many things.

Thus we are regularly subjected to the social/political musings of actors.

I've always found that doctors, outside of their chosen specialty, are not very bright.

MadisonMan said...

Was this doctor in a fraternity in college?

Unknown said...

Medicine is an art, not a science. It is supported by many sciences, but so is ceramics. Medicine evolves by examining and adopting what works.

Law evolves (as far as I can tell) adversarially (sp?), someone sets a limit based on desires and then lawyers try to figure out how to get around it. I know that's an oversimplification, but I'd rather be ruled by what works than desire frustrated.

Jay said...

Ann Althouse said...

My point is that we are overvaluing doctors in politics


We are?

Just because a doctor runs for office and wins?

That is nonsensical.

Brennan said...

Oh, Freder wants proof that a majority of doctors oppose the ACA, but doesn't appear to want it if you claim a majority do support it.

It must be one of those days that end in day.

Jay said...

AReasonableMan said...

A majority of physicians support the ACA,


No they don't.

April Apple said...

"Even with the American Medical Association’s endorsement, a large majority of American physicians remain staunchly against Obamacare. They see the program as creating an undue burden on their practices in light of decreased reimbursement, increased bureaucratic oversight, and a complex array of unnecessary and intrusive technological mandates which will further distance them from their patients.

April Apple said...

Official Government Lies about the ACA:

1. If you like your plan, you can keep your plan.
2. If you like your doctor, you can keep your doctor.
3. Families will on average save $2500 annually.
4. Obamacare won’t add a dime to the deficit.

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

What is going on with this promotion of doctors in the American political scene? There's something odd and excessive about our respect for them.

What is going on with this promotion of gun controllers in the American political scene? There's something odd and excessive about our respect for them.

What is going on with this promotion of "moms" in the American political scene? There's something odd and excessive about our respect for them.

What is going on with this promotion of racial grievance agitators in the American political scene? There's something odd and excessive about respect for them...

Jim said...

I'm a ks republican who voted for Gary Johnson. Seriously folks, Pat Roberts is the least of our problems. Don't waste your money on dr wolf, who I'm sure is a nice guy.

Biff said...

Surely, there must be a way to draw parallels between the physicians employed to do the bidding of the people and the surgeons employed to do the bidding of the Duchess of Alba.

The Crack Emcee said...

How about we look for leadership skills in somebody? That would be new.

Can we find someone who shows a bit of flair for governing? Someone, maybe, quotable? Who makes good sense? I don't see a lot of those.

Would we consider someone who doesn't care for the limelight? Who just wants to do a good job at something, and doesn't even want your pat on the back, but only to be left alone to do it - would we take that guy?

Fucking doctors and lawyers.

Power whores, the lot of 'em,...

jacksonjay said...


People know to mistrust lawyers.

Quote from noted Law Professor!

Speaks volumes!

DEK said...

Are the values of the "helping professions", admirable as they might be, desirable in one who governs? This may also be asked of teachers, social workers, nurses, psychologists, veterinarians and dental assistants.

One might also ask if the single-minded advocacy of lawyers prepares them to represent all the people and fairly govern a nation.

Have we, in fact, a sufficient pool of persons of the talent and disposition to perform the offices of so large and far-reaching a government as we have constructed?

Ann Althouse said...

"Speaks volumes!"

It does?

Seems like it speaks the most obvious point in the world.

Pettifogger said...

If there is an increase in physicians interested in running for political office, might it not be because politics is increasingly intruding into the practice of medicine? Obamacare is a notable example, but it is not the only one. Prosecution of physicians treating chronic pain is another. There are many examples.

Pettifogger said...

I saw a references in the comments to the "helping professions." In a Venn Diagram, there would be substantial overlap between members of the "helping professions" and what I refer to as the ministering class. I do not want to be governed by people who perceive me more as a social service client than as a citizen.

jacksonjay said...

Seems like it speaks the most obvious point in the world.

Exactly

AReasonableMan said...

April Apple said...
"Even with the American Medical Association’s endorsement, a large majority of American physicians remain staunchly against Obamacare.


April, there are no numbers in that link, it is just one nutjobs opinion.

As far as I can tell there is no good survey specifically on physicians attitudes but, "the American Medical Association, the American College of Physicians, the American Academy of Family Physicians, the American Academy of Pediatrics, the American Osteopathic Association, the American Psychiatric Association, and the American College of Cardiology all endorsed the ACA. These groups represent hundreds of thousands of physicians across a wide range of medical sub-specialties."

It is pretty clear where the majority of physicians stand based on the stance of their professional organizations. This is particularly striking given that MDs are likely to receive a reduced rate of compensation as health care goes forward and therefore have some vested interest in opposing the legislation.

Pogo is Dead said...

Get Congress out of medicine and the doctors will get out of Congress.

But shit, being Senator is far easier and more lucrative than grinding out 40-60 patients a day in Family Practice in Squat-n-pee, Utah or Toadbutt, Nebraska, with $150K in student loans and Obamacare set to screw you eight ways to Tuesday.

So why not?

BrianE said...

Well, for one thing, doctors are smarter than lawyers.

And for another thing, since congress is limiting the earning potential of doctors, it makes sense for them to gravitate to where the money is. There seems to be no limit to the earning potential of congressmen.

It's why Dillinger said he robbed banks.

Jay said...


It is pretty clear where the majority of physicians stand based on the stance of their professional organizations.


It is pretty clear you don't seem to have the most basic understanding of how these things work.

Survey: N.Y. Doctors Adamantly Oppose ObamaCare

Doctors are skeptical and confused about Obamacare, survey finds

60% of Doctors believe: health care reform will
negatively affect patient care

[Note that 70% of doctors surveyed in 2011 disagreed with the AMA's position on the ACA]

I could do this for the next hour, but there is no point.

I could also explain to you why the AMA and other groups endorsed ObamaCare, but that, too, would be pointless.

Jay said...

"When asked how they felt about the Affordable Care Act, 55 percent said “repeal and replace” the new law while 40 percent said “implement and improve” the ACA.

Fifteen percent of doctors reported they were switching their votes from Obama in 2008 to Romney in 2012. Among the top reasons why physicians said they were switching their votes:

-The Affordable Care Act drew the most responses – and its lack of addressing tort reform
"

AReasonableMan said...

Bruce Hayden said...
I grew up with lawyers.

But, I think that a law degree should disqualify you from running for political office, and esp. at the national level.


It is instructive to look at the fate of Steven Chu. He is a Nobel prize winner and a very successful scientific administrator yet his time in politics is viewed very negatively. From a rational viewpoint he did a perfectly fine job but he lacked the lawyers knack for spin and deception which doomed his tenure in the eyes of the media. The natural mendacity of lawyers means that they will almost always outcompete more technically competent people. Margaret Thatcher and Angela Merkel are interesting exceptions, although neither was a first rank scientist.

William said...

Physicians are not a monolithic group. Surgery is an altruistic form of sadism. Surgeons surge. They're competitive, decisive, and lots of them are jocks. In another life they'd be brokers.....Internists are pensive, gentle, and empathic. In another life they'd be stock analysts or even English teachers.......When you think of doctors as arrogant pricks, you're probably thinking of a surgeon. When you think of doctors as kindly, decent men, you're probably thinking of an internist.

Michael K said...

"A majority of physicians support the ACA, so they have that going for them. On the other hand there is Michael K. It's a tough call."

It nay be an indicator that the White House photo op of "doctors" supporting Obamacare included non-doctors in white coats. Like the girl fourth from the right in the photo.

The doctors who did support Obama are mostly employed on salary and politically leftist.

A few years ago, there was a student group supporting single payer. I was asked to be a faculty adviser to that group because I was perceived as knowing about health policy. I don;t believe that group exists anymore. At least it hasn't met in several years.

I used to tell students that the worst of the reform turmoil would be over by the time they were starting practice. I don't think that is true anymore.

A friend was over for dinner last night. She is an OR supervisor. The hospital is going through another wave of layoffs in spite of the fact that they are insanely busy. They are trying to cut expenses to match the declining revenues. It will get ugly.

A few years ago, I spent some time studying other systems to see how health reform should go. If anyone, like Freder, is interested it is here.

Revenant said...

why empathize with a man who flaunts his lack of empathy?

Kind of missed the point, didn't you? It is about picking the person you think can do the job best, rather than relying on emotions.

William said...

The physician in question is a radiologist. He examines X-rays, not patients. He was making fun of be X-rays and not the patients. There's very little dilettante interest in reading X-rays. I presume the x rays and the jokes were posted for those in the know and not for general consumption. This looks like a manufactured controversy.

William said...

If you want that vision thing, go to an ophthalmologist.

cubanbob said...

"I know too many doctors and nurses to get bend out of shape at gallows humor."

Yes, exactly. That's my point!"

You overlook the fact that the lawyers in congress have put the country on the gallows.

AReasonableMan said...

Jay said...
I could do this for the next hour, but there is no point.


No there would be a point. You would fully demonstrate your ability to cherry pick from third rate web sources any dubious information that you can find in order to bolster a weak case. As I noted, MDs will lose financially from the ACA. There would never have been universal support for the ACA. We need medical costs to go down. Only the hopelessly stupid person doesn't recognize this.

Brennan said...

The physician in question is a radiologist. He examines X-rays, not patients.

How do you know this?

Big Mike said...

@Brennan, because that's what radiologists do for a living.

wholelottasplainin' said...

"Forewarned is forearmed."

And forearmed is half an octopus.

(don't hate me; hate the old comic strip "Pogo" for that one)

Jay said...

ReasonableMan said...

Jay said...
I could do this for the next hour, but there is no point.

No there would be a point. You would fully demonstrate your ability to cherry pick from third rate web sources any dubious information that you can find in order to bolster a weak case.


And there you have it.

Jay said...

There would never have been universal support for the ACA.

Hey troll, nobody said anything about "universal support"

The majority of doctors do not support the ACA.

That is clear.

Your claim that they do is false.

In response to your silly claim being abjectly false, you do what trolls do.

Move the goal posts.

khesanh0802 said...

"The first thing we do, let's kill all the lawyers."

The Crack Emcee said...

"Why empathize with a man who flaunts his lack of empathy?"

All this place is populated with is a lack of empathy.

paul a'barge said...

Where do we get this idea that a background in medicine is particularly apt for lawmakers?

Wow, that's one really, really stupid question.

What are you a lawyer, or something? Oh wait ...

Jay said...

AReasonableMan said...

A majority of physicians support the ACA,


No they don't, liar.

70% of doctors surveyed disagree with the AMA's stance on ObamaCare.

Your response that any source disagreeing with your comical ignorance is "3rd rate" is full troll.

Congrats, troll.

Michael K said...

"We need medical costs to go down. Only the hopelessly stupid person doesn't recognize this."

That is one reason why I oppose Obamacare. It does not do that. In fact, it combines the worst sort of perverse incentives with forcible rationing. The question will be which side wins. The only way to control costs is to use market forces instead of forcible rationing. If you think rationing would work, please explain why the mandates for employers have been postponed several times.

That's why I supported the French system in 2008 when I wrote those posts. The Canadian system just creates medical tourists like the ones who go to Spokane or Minneapolis for care.

The French system provides basic care for everyone and allows those who wish to pay more to do so.

Jay said...

By the way, I love that this silly troll refereed to Jackson & Coker as a "3rd rate" source.

Hilarious.

Michael K said...

Jay, your link doesn't work. I agree but it would be better to have a working link.

Jay said...

AReasonableMan We need medical costs to go down. Only the hopelessly stupid person doesn't recognize this.

That's great, bozo.

But um, that was a point I never talked about.

Isn't it funny that when you're presented with information that directly refutes your comically ignorant world view you start going off on tangents?

Michael K said...

" The effect, of blacks being outnumbered 6 to 1, couldn't be clearer,"

Crack, there is a solution to your problem. Detroit comes to mind.

Jay said...

Sorry, here is the working link.

agree with the AMA’s Position on Health Reform

70% say no.

Dr Weevil said...

Hmmm. 92 comments, several of which compare Wolf's open lack of empathy to Obama's ability to fake empathy, and no one mentions that they're second cousins? (The linked story's "distant cousins" is hogwash: I've met lots of my 2nd cousins, and "distant" to me implies 4th or 5th cousins, maybe 3rd, but definitely not 2nd.)

April Apple said...

Sorry ARM - but YOU LIE.
Most physicians HATE the ACA. The only ones who like it are staged and/or are on salary or are leftwing pro-single payer nutjobs.

William said...

On the whole, I think we can all be glad that Bill Clinton's interest lay in the field of law and politics and not medicine. He would have been particularly problematic as a gynecologist. A physician can be too empathic.

elkh1 said...

Only lawyers are qualified to lord over us, the little people. That's what "lawyer up" means. Nobody says "doctor up". But one may doctor evidence to score an advantage in court. Can't trust those doctor scums, can we?

Lawyers are uniquely able to churn out thousands of pages of lawyerly speaks that no two persons could agree on the meanings. The bickering parties go to court to see lawyerly priestlings read the entrails, the high priest would determine which party has more claims to the entrails. Ultimately the Supreme High Priests would interpret birds flight patterns to settle the Law for the moment.

Anglelyne said...

My point is that we are overvaluing doctors in politics...

We are? Says who?

...and that our physical need for them distorts our thinking about them and power-seekers are leveraging this distorted thinking.

Who's this "we" you keep talking about? It'd be nice if you gave an actual example of how this alleged psychological attitudes toward doctors is driving voting. Yeah, what else could be driving an uptick in doctors' interest in politics these days? It's a puzzler, it is.

So far your "evidence" for the existence of this distorting deference seems to be the mere fact of X number of doctors in elected office, or merely running for office - and one douchebag radiologist with a facebook page. This "logic" could apply to any group occupying office, with as much merit.

Do people in general respect the profession of medicine more than they respect law or career politics? For the most part, yes, and for good reason. (Though that will change as/if conditions kill the attractiveness of the profession to high-quality entrants.) It's quite a leap from that to the befogging uncritical worship you're positing here.

The only people I can think of who exhibit an "awe of" and mindless "deference toward" doctors are a certain subset of silly people who are prone to "distorting deference" toward other kinds of personal attributes of politicians that have nothing to do with ability to govern wisely, either. Cough, cough. I doubt we're any worse off with them voting for an "M.D.", than we are with them voting based on those other attributes.

The Crack Emcee said...

Michael K said...
" The effect, of blacks being outnumbered 6 to 1, couldn't be clearer,"

Crack, there is a solution to your problem. Detroit comes to mind.



I'm from South Central, Los Angeles/Compton, Mike - you know, near you.

Freder Frederson said...

70% of doctors surveyed disagree with the AMA's stance on ObamaCare.

This, and the other study cited, are surveys, not scientifically conducted polls. Surveys are pretty much worthless (other than as a tool to verify a predetermined outcome).

The Cracker Emcee said...

"How about we look for leadership skills in somebody? That would be new.

Can we find someone who shows a bit of flair for governing? Someone, maybe, quotable? Who makes good sense? I don't see a lot of those.

Would we consider someone who doesn't care for the limelight? Who just wants to do a good job at something, and doesn't even want your pat on the back, but only to be left alone to do it - would we take that"

Jeez, Crack. That's an unusually rational comment.

Seeing Red said...

Lack of empathy, hmmm. Like the fact 2 of my friends in the medical profession lost their jobs due to Obamacare and they both voted for Obama?

Keep breaking those eggs! Forward!

Jay said...

Freder Frederson said...

This, and the other study cited, are surveys, not scientifically conducted polls. Surveys are pretty much worthless (other than as a tool to verify a predetermined outcome).


Fingers in ears: LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA

If you think polls are "scientific" you are a scientific illiterate.

Jay said...

By the way, you know you're either ignorant or a liar if you don't understand why doctors are surveyed by industry groups and don't pick up the phone when Public Policy Polling calls.

My goodness, are you people pathetic in your bitter clinging.

Phaedrus said...

The lawyer questions whether we have too many doctors in Congress!

Marshal said...

Ann Althouse said...
Lawyers are not overvalued.


Academics are.

Seeing Red said...

Lawyers devalued themselves..

Marshal said...

dmoelling said...
Why not Doctors? At least they are not professional politicians. I'd rather live with a few gaffes. We have Lawyers (and doctors) in congress because they are one of the few occupations that can interrupt their career at minimum cost to run for office. Since medical issues are such a large part of the economy why not have at least 50? Ditto for ex-military, business guys, farmers etc.


Teh thing about diversity: unless it deals with body parts the left is absolutely against it.

Unknown said...

A man in a hot air balloon realized he was lost. He reduced altitude and spotted a woman below. He descended a bit more and shouted, "Excuse me, can you help me? I promised a friend I would meet him an hour ago, but I don't know where I am."

The woman below replied, "You're in a hot air balloon hovering approximately 30 feet above the ground. You're between 40 and 41 degrees north latitude and between 59 and 60 degrees west longitude."

"You must be a MEDICAL DOCTOR," said the balloonist. "I am," replied the woman, "How did you know?"

"Well," answered the balloonist, "everything you told me is, technically correct, but I've no idea what to make of your information, and the fact is I'm still lost. Frankly, you've not been much help at all. If anything, you've delayed my trip."

The woman below responded, "You must be a POLITICIAN. And a LAWYER" "I am," replied the balloonist, "but how did you know?"

"Well," said the woman, "you don't know where you are or where you're going. You have risen to where you are due to a large quantity of hot air.

You made a promise which you've no idea how to keep, and you expect people beneath you to solve your problems. The fact is you are in exactly the same position you were in before we met, but now, somehow, it's my fault."

Sam L. said...

Beats lawyers! Too many already in office.

Revenant said...

We need medical costs to go down. Only the hopelessly stupid person doesn't recognize this.

In retrospect, then, increasing demand for medical professionals' time (by expanding insurance coverage) without doing anything to increase the *supply* of medical professionals' time was an insane idea.

Increased demand, constant supply, prices go up... who could have forseen this???

Pogo is Dead said...

"Increased demand, constant supply, prices go up... who could have forseen this???"

Obviously, further controls are needed.

jr565 said...

I think doctors get extra points for handsomeness because they're doctors. If he looked like that and worked at the Post Office he probably wouldn't be called "Handsome".

RecChief said...

do more doctors make sor shorter legislation? That is, can they write a bill that isn't 800 pages long? if so, then we should have more of them in there.

Actually, I would think that the type of law practiced by the John Edwards type of ambulance chaser are the reason people mistruct lawyers.

AReasonableMan said...

Jay did you read the fine print?. "Between August 1 and August 29, 2011, Jackson & Coker conducted a online survey of 1,611 physicians. Jackson had a response rate of 1.44 percent from the 111,792 email invitations distributed."

A 1.44% response rate will give you any result you want, in this case obviously people disaffected with the AMA.

RecChief said...

And if you want to see gallows humor, hang around an Army barracks sometime. Although the sensitivity brigades are making inroads there too

jr565 said...

Revenant wrote:
In retrospect, then, increasing demand for medical professionals' time (by expanding insurance coverage) without doing anything to increase the *supply* of medical professionals' time was an insane idea.

Increased demand, constant supply, prices go up... who could have forseen this???

Well put.
And I'll add, "Only the hopelessly stupid person doesn't recognize this" just to rub it in a little.

Seeing Red said...

What difference, at this point, does it make?

AReasonableMan said...

Revenant said...
In retrospect, then, increasing demand for medical professionals' time (by expanding insurance coverage)


Are you trying to argue that the uninsured were not treated prior to the ACA, because a whole lot of Republican dogma says otherwise?

Michael K said...

"I'm from South Central, Los Angeles/Compton, Mike - you know, near you."

So, who outnumbers you ? Illegals ? I understand they are taking over Compton. True ?

You are still swinging after the bell, Crack.

Seeing Red said...

Tsk tsk tsk that's not very empathetic!

Michael K said...

"A 1.44% response rate will give you any result you want, in this case obviously people disaffected with the AMA."

In that case, the fact that 75% of doctors DON'T belong to the AMA might give you a clue.

You won't believe what anyone tells you that disagrees with your preconceptions. Why ask ?

Revenant said...

Are you trying to argue that the uninsured were not treated prior to the ACA, because a whole lot of Republican dogma says otherwise?

What I said was that expanding insurance coverage increased demand for medical professionals' time. Not that no uninsured person ever saw a doctor before.

Do you disagree? Because my statement is completely in line with the left-wing dogma you've been spouting this past few years.

Seeing Red said...

That's in response to who knew that increasing demand.....

AReasonableMan said...

This article in todays WSJ addresses the health care costs and how difficult it is to comparison shop. Anyone who thinks the ACA is not just one part of a large number of changes coming to the medical care profession is fooling themselves. Health care costs are much too high relative to other economic sectors and they are strangling economic competitiveness for the rest of the country.

AReasonableMan said...

Revenant said...
What I said was that expanding insurance coverage increased demand for medical professionals' time. Not that no uninsured person ever saw a doctor before.

Do you disagree?


There is not enough information to make a sensible decision at this point, despite your certainty on the issue. Clearly the uninsured received considerable medical care before the ACA. It is believed that this care was delivered very inefficiently, in large part through emergency room care which is both costly and very time consuming. If this is true and if the ACA shifts some of this care to more efficient primary care providers then your argument is probably wrong.

AReasonableMan said...

Michael K said...
"A 1.44% response rate will give you any result you want, in this case obviously people disaffected with the AMA."

In that case, the fact that 75% of doctors DON'T belong to the AMA might give you a clue.


25% still beats less than 1.44% of 25%

eric said...

Yeah, what's with all these doctors in Congress?

We definitely need more lawyers.

Surely our proprietor is pulling our legs here.

Joe said...

I don't see a lack of empathy, rather a lack of understanding of scientists (and engineers.)

A truly fascinating TV show is about Air Disasters. Yes, there is human tragedy involved, but there's also the puzzle as to why it happened, the solution of which will [hopefully] save lives in the future. Thus, were I to say that my favorite air disaster (as just point of reference) is BOAC Flight 781, it's not because I celebrate the deaths or lack empathy, it's because the case is fascinating from an engineering point of view. Moreover, the reasons for this crash led to much greater air safety.

Likewise, in Medicine, a particular case may be fascinating because it was especially difficult to solve and/or because it simply was fascinating. (Man comes into emergency room with an iron rod through his head.

Thought 1: Ick.

Thought 2: Wow, poor man.

Thought 3: How is he still alive! We must find out.

Thought 4: If he stays alive, what effect does this have on his personality?

(The lawyer version:

Thought 1: Who can we sue?

Thought 2: If he lives, can we demand more money?

Who has more empathy?)

n.n said...
This comment has been removed by the author.
Revenant said...

Health care costs are much too high relative to other economic sectors and they are strangling economic competitiveness for the rest of the country.

How strange that one of the most highly-regulated and highly-subsidized sectors of the economy should be so inefficient and expensive.

n.n said...

The beautiful mother laughs at murdering innocent human lives and runs for office. The lawyers (i.e politicians, judges) should stop rationalizing her choice.

Revenant:

Obamacare addresses neither affordability nor availability. It is a revenue program intended to compensate for progressive devaluation of capital and labor, as well as preserve the status quo, while creating a perception of reform. In the best case, it will, as other fiscal policies unbacked by productivity, sponsor corruption. In the worst case, it will force procedural rationing of medical care, and shift the costs throughout the economy, population, and world.

It was probably a Democratic imperative, because they govern in populous, highly subsidized and financed districts, which are especially vulnerable to directed misalignments in fiscal, economic, and social development.

I think their ball of yarns is so convoluted, that no one knows how to unwind it without dashing dreams and the whole ball of hope. I also think that a minority, or perhaps a majority, of Republicans are similarly trapped. In the worst case, there are convergent interests which means there are no competing interests to prevent them from running amuck.

The resolution is not forthcoming. We know the causes. We know the appropriate treatment. We will continue to treat symptoms. Everyone hopes that compensating for the consequences of "good intentions" will be sufficient. Meanwhile, the disease festers.

traditionalguy said...

As an attorney I recall that we are in a competitive fact based system on each case, while MDs are in a cover up and no competition system on each patient.

That is expressed in the old aphorism that lawyers put their mistakes in writing while MDs bury their mistakes.

Michael K said...

"In that case, the fact that 75% of doctors DON'T belong to the AMA might give you a clue.

25% still beats less than 1.44% of 25%"

ARM, I know math is hard but the original argument was that 70% of doctors opposed Obamacare. The AMA, along with the insurance industry, were bought off by the Democrats to support Obamacare.

Does that suggest something to you ?

Like maybe they bet on the wrong horse ?

No ?

Is 75% close to 70% ?

Revenant said...

There is not enough information to make a sensible decision at this point, despite your certainty on the issue. Clearly the uninsured received considerable medical care before the ACA.

Of course most of the uninsured saw doctors before. That's not the issue. The issue is whether more of them access medical care now than before.

There are two possibilities:

1. Yes, more of them see doctors now. Hey, how about that -- increased demand.

2. No, they see doctors either as frequently or less frequently now. In which case ObamaCare has failed at its primary function: expanding access to care.

Like I pointed out before the law even passed, the unavoidable trade-off is between coverage and average cost. The Democrats' promise to reduce costs while expanding coverage was economically insane, and "but we need to do *something*" is no excuse.

Revenant said...

Obamacare addresses neither affordability nor availability. It is a revenue program intended to compensate for progressive devaluation of capital and labor, as well as preserve the status quo, while creating a perception of reform.

Rule #1 of politics: never assume the existence of a complicated and carefully implemented conspiracy when "politicians are incompetent" explains the same set of facts.

Inga said...

Physicians for National Health Program

As for people in the medical field not appreciating gallows humor, that has really not been my experience after 30 years in the field. Physcians can't be stupid like Rep.Steve Stockman or Louie Gohmert, I'm pretty sure any doctor would be better than them.

Michael K said...

"Man comes into emergency room with an iron rod through his head. "

I've had a couple. Answers ?

One was a guy at San Onofre nuclear power plant. He was grinding a chisel when the grinder swallowed it and spit it out into his forehead. Result ? We took it out and he seemed unchanged.

One was a teenager who went with friends to a beach in San Clemente. There was a Mexican gang there and the teens tried to leave quickly. As they were were driving up the road away from the beach, one of the gang had a sharpened paint roller handle and swung it at the kid in the front passenger seat. The kid came in with the paint roller through his head.

He died.

Althouse mentioned another case

Inga said...

Dead Pogo, the nation made an actor POTUS. So why can't a comedian be a Senator?

AReasonableMan said...

Revenant said...
Of course most of the uninsured saw doctors before. That's not the issue.


Of course it is the issue. Channeling primary health care for millions of people through emergency rooms is crazy economically. Properly implemented there should be a reduction in health care costs by moving these people to primary care physicians. It should be a win-win, with both lower costs and better overall health care. It is a dynamic problem but you seem to only want to think about it statically.

Michael K said...

Inga, Himmelstein and Woolhandler are Harvard full time profs who have been pushing this for more than 20 years. They do not practice and would be unaffected. The docs at the Obamacare press conference, those that were really docs, were new graduates employed by hospitals. I looked them up.

I was at Dartmouth right after Hillarycare was defeated. There were a lot of long faces as they had anticipated that they would be running Hillarycare. These legislative nightmares, like the Massive British flooding or the California drought, have pressure groups, often driven by self interest but sometimes by simple clueless ideology, who support the legal mess.

The British Socialist government after World War II kept Britain in a poverty state while Germany and Japan recovered after losing the war Britain won.

Michael K said...

"Channeling primary health care for millions of people through emergency rooms is crazy economically. Properly implemented there should be a reduction in health care costs by moving these people to primary care physicians."

More ARM cluelessness.

Massachusetts did not see a decrease in ER visits .

Medicaid increased coverage raises ER visits because people who use Medicaid don't plan ahead and doctors don;t want to see them anyway.

Inga said...

Michael, my family has two physicians as friends . One is a Pediatric Dermatologist, in favor of a National Health Program, the other is a Orthopedic Surgeon, against it. There are plenty of docs who belong to the organization I linked to that are currently practicing.

Jim M said...

Because lawyers and law school professors have done such a wonderful job.

Seeing Red said...

I wasn't aware Reagan was active in the industry before he ran for president like Franken was. So running SAG I think it was and the governorship of California was what?

Michael K said...

"One is a Pediatric Dermatologist, in favor of a National Health Program,"

That sounds like a university medical group specialty. Is that person, probably female, in private practice ?

jr565 said...

Crack Emcee wrote:

"What did jr565 tell me yesterday? Blacks should "accept the cards you were dealt"? Of course, if we did that, slavery would STILL be going on"

Except blacks are no longer slaves. Why then dwell on that hand that you were dealt, as opposed to the hand you have now?

Marshal said...

Revenant said...
How strange that one of the most highly-regulated and highly-subsidized sectors of the economy should be so inefficient and expensive.


The tragedy is that the left's only response is to push for more regulation and subsidy.

cubanbob said...

There is not enough information to make a sensible decision at this point, despite your certainty on the issue. Clearly the uninsured received considerable medical care before the ACA. It is believed that this care was delivered very inefficiently, in large part through emergency room care which is both costly and very time consuming. If this is true and if the ACA shifts some of this care to more efficient primary care providers then your argument is probably wrong."

Those people for the most part were either covered by medicaid or medicaid qualified so the ACA really doesn't change much. And those people will still be going to the ER as they don't want to wait days or weeks for treatment, a situation that has not been or will be improved by the ACA.

So other than illegal immigrants who might be somewhat helped by the ACA and again that is tenuous at best the ACA doesn't improve things for those reliant on medicaid but has demonstrably worsened the situation for the privately insured.

Ignorance is Bliss said...

AReasonableMan said...

Channeling primary health care for millions of people through emergency rooms is crazy economically.

I know that an emergency room is more expensive for basic treatment. ( The specific example I heard was a visit for a sprained wrist was 3 times more expensive at an emergency room than at a doctor's office. ) Does anyone know why it costs more at an emergency room?

It seems it should cost less. They've got efficiency of scale for medicine, supplies, computer systems, etc. And having a large number of minor injuries should improve their resource utilization. They need to be staffed and equipped to handle X number of critial, can't wait patients at a time. But most of the time they have half that number or less. If they have non-critical patients too then they can better utilize the resources during the lulls.

cubanbob said...

As for lawyers versus doctos in government perhaps we out to try getting engineers in to office. Engineers in their profession have to deal with reality and find workable solutions.

Jay said...

AReasonableMan said...


A 1.44% response rate will give you any result you want,


So in other words, silly, grand pronouncements that "doctors support the ACA" are better.

Jay said...

AReasonableMan said...

Channeling primary health care for millions of people through emergency rooms is crazy economically. Properly implemented there should be a reduction in health care costs by moving these people to primary care physicians.


You know absolutely nothing, not 1 single thing, about this topic.

Why you want to just post these bromides, other than to troll, isn't clear.

What is the point?

Jay said...

AReasonableMan said...


25% still beats less than 1.44% of 25%


Right, because every single doctor who belongs to the AMA supports the AMA's position on ObamaCare!

Why do you persist in this silly trolling?

Seeing Red said...

Engineers might not be as empathetic. It either works or it doesn't.

Michael K said...

"It seems it should cost less. They've got efficiency of scale for medicine, supplies, computer systems, etc."

A large part of the problem is the 24 hour nature of ERs. When I ran a trauma center, we set up an after hours clinic nearby to keep the "worried well" out of the ER. Later the pediatricians kept it going as "Kids Doc" which they staffed as an after hours clinic so they could share the burden of after hours care.

It's still going.

It was open until about 10 PM which was economical.

Pogo is Dead said...

I support doctors running for Congress because Obama has become an enema of the people.

Skyler said...

The politicians have politicized medicine and you think that doctors should not participate in the process that is the biggest transformation of our society since the New Deal?

Good grief.

Doctors are very smart. They are more than capable, and generally more trustworthy than laawyers.

Michael K said...

"Channeling primary health care for millions of people through emergency rooms is crazy economically. Properly implemented there should be a reduction in health care costs by moving these people to primary care physicians."

ARM, You accomplished something. You and Inga got me to log onto the physician only website, called Sermo, that I hadn't looked at in years. A quick perusal of the politics segment tells me that physicians, and Sermo has 200,000 subscribers all MD or DO, are not happy with Obama or Obamacare. I'll look to see if they surveyed the members.

chickenlittle said...

Pogo is Dead said...
I support doctors running for Congress because Obama has become an enema of the people.

Public Enema?

Pogo is Dead said...

NHS doctors favor socialized medicine.

But who cares?
It's outcomes have been ugly for England in cancer care, heart attacks and ER coverage.
And they are broke as hell.

A majority of MDs wanting a government takeover of healthcare, if true, tells me nothing other than that they were educated by the fools and liars running US public schools and universities.

Ignorance is Bliss said...

Michael K said...

A large part of the problem is the 24 hour nature of ERs.

Michael- thanks for the response. But why would the 24 hour nature of the ER raise costs so much? Are doctors being paid a huge shift premium for the off hours? Even if the doctors were getting paid double that should result in significantly less than a doubling of the patient bill.

Note I'm not accusing anyone of overcharging, or anything like that. I'm just trying to understand

AReasonableMan said...

Jay said...

If you think polls are "scientific" you are a scientific illiterate.

Fingers in ears: LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA

What is going on with this promotion of "moms" in the American political scene? There's something odd and excessive about our respect for them.

My goodness, are you people pathetic in your bitter clinging.

Why you want to just post these bromides, other than to troll, isn't clear.

You know absolutely nothing, not 1 single thing, about this topic.

That is nonsensical. What is the point?


Michael K said...

Jay, your link doesn't work.

Ignorance is Bliss said...

I suspect a good bit of the high price is due to cost shifting. Because the ER treats people who could not pay, they were then charging everyone else more to cover their losses. Also, the hospital must be equipped with lots of expensive equipment, in case it is needed. The cost for those are spread across everyone, even those who don't use it.

However, if the reason the ER is so expensive for routine treatment is due to cost-sharing, then shifting usage to primary care physicians doesn't help. The costs are still there, even if they are no longer shifted. The primary care visit would cost less, but those people who actually need the ER would have to pay more, because the capital expenses must be paid for by fewer patients.

Inga said...

2009 poll finds most doctors support a public option.

I'm looking for a more recent poll. I suspect it's closer to 50/ 50 for/against.

Bruce Hayden said...

I am not sure why the leftists here would think that physicians would love ObamaCare. It greatly increases their paperwork, in many cases pushing them into larger and larger practices, reduces their pay, as well as their freedom to practice medicine. And, now, they are having to dump long time patients whose new policies don't include the doctors - often in the middle of treatment. The ones who work for large companies, maybe. Those who work for the government already, sure. But all the physicians in small to medium practices? Highly unlikely.

Inga said...

"I am a Republican doctor and I favor Single Payer"

Michael K said...

" But why would the 24 hour nature of the ER raise costs so much? "

First, you have to understand now bad hospital billing is. What you see if a "retail" charge that is intended for the insurance company, which then pays a negotiated percentage of that charge. The negotiated part may be a small fraction. Look at a Medicare EOB sometime. I go to a pain doc sometimes and he charges $120 for an office visit. Medicare pays him $11. Most primary care docs now live on the co-pays.

The ER bill, like most hospital bills, is not intended to be actually paid like you would pay an electric bill.

The illegals who fill ERs never pay anything. The Medicaid patients who fill most of the rest, don't pay and Medicaid pays a small fraction. When I used to see Medicaid (MediCal in California) patients 30 years ago, most of them were coming for varicose vein injections (I was a vascular surgeon) and MediCal paid me six dollars a visit for the injection. That didn't pay my costs so I quit seeing MediCal.

Primary care docs who are forced to see MediCal because of where they practice, often pad bills to get some decent amount of payment. This is actually fraud and once in a while there is a scandal.

When we admitted trauma cases that were MediCal, there was usually big ticket items and the payment was based on that. Most of our traumas were actually insured because of where we were (South Orange County) and mod were auto accidents. If we had been in an inner city location, we would not have been enthusiastic about a trauma center and most are hospital based and the docs are paid by the hospitals.

The Kids Doc, in contrast, is run by private pediatricians and is in an office building, not the hospital. A lot of their patients have insurance or it would never work.

Some Urgent Care offices are on the same principle. It's not a hospital with all their fixed costs. Hospitals, of course, hate this and one reason the AHA signed on to Obamacare was to use it to shut out Urgent Care and doctor owned facilities like surgery centers and specialty hospitals. It will be interesting to see how it plays out.

My friend who was over last night for dinner told me they are laying of staff in spite of being very busy. This will drive surgeons away who want good service in scheduling surgery and getting things done instead of waiting around.

Obamacare may drive more doctors away from hospitals and add to the trend to cash practice. The doctor owned hospitals, excluded from Obamacare, may turn to the cash model.

According to the Patient Protection and Affordable Care Act, no physician-owned hospitals may start or current ones expand.

It will be interesting to watch.

Michael K said...

Inga, the guy who wrote that column thinks doctors would be in charge if we went to Medicare for all. He is a dreamer or not serious.

You might read my own ideas on reform written before Obama ran for president. I favor a French style system. I doubt you will read any of it because I think you are a lefty partisan and uninterested in real ideas.

Drago said...

Inga: "Dead Pogo, the nation made an actor POTUS."

Taking time out from defending dems from calling women "cunts", Inga pops up to reflexively leave out the most salient aspects of Reagans career:

1) Head of the Screen Actors Guild during a very interesting time
2) 8 years as the spokesperson for GE theatre (wherein he visited approximately 135 GE research and manufacturing facilities and met over a quarter-million people.)
2a) These would be manufacturing/factory people, union people, non-union people. The heart of the US productive sector in addition to the leaders of those businesses and industry
3) Governor for 8 years of the largest state in the union.


But hey, he was just an actor.

And obama was what again?

Pogo is Dead said...

A large proportion of patients in EDs do not have insurance, a
phenomenon attributed to the 1986 Emergency Medical Treatment and Labor Act.

EMTALA requires hospitals that participate in Medicare to:
1. Give a medical screening exam to any patient who presents to a dedicated ED or requests treatment for an emergency medical condition while on the hospital campus;
2. Stabilize the condition if feasible at the facility; and
3. Transfer the patient to another appropriate medical facility if the patient cannot be stabilized at that hospital.

That is, free care.

Ignorance is Bliss said...

Again, thanks for the info. It seems to confirm my suspicion that the high costs are really cost-shifting, and therefore shifting where the patients are seen will make little difference to the total amount of healthcare spending.

That is assuming that the ACA shifts usage away from the ERs. MassCare had the opposite experience.

Inga said...

Drago, would you like to link to the place in which I called some woman here a cunt?

Revenant said...

Drago, would you like to link to the place in which I called some woman here a cunt?

Reading comprehension: not Inga's strong suit.

Inga said...

Michael K, I've already read it, you've directed me to it before. I actually agreed with you at some point and then you proceeded to ignore what I said lambasted me for agreeing with you on the French model! Then I decided you were not to be taken seriously, or perhaps you were simply being contrary. I really don't know and I'm tired to tryin to figure out where you are coming from on an given day.

Inga said...

Revenent, same request goes to you. If you make an assertion, back it up. Speaking of people who love being contrary, that would be Revenant.

Oh yes. :)

Pogo is Dead said...

Almost half of EDs report shortages of on-call physicians, especially neurosurgery, plastic surgery, and orthopedics.

As a result, many hospitals
subsidize specialists for their
on-call duties. This compensation may take the form of stipends to specialists for taking call, guaranteed pay for services rendered to uninsured patients, or other fee arrangements.

Many EDs face difficulties getting paid for services. A 2003 study of two HMOs in California found that one of the categories of most frequent denial
was emergency care (17% were denied).

"The ED differs from many other hospital specialties in that the ED has relatively high fixed costs, but may exhibit relatively
small and potentially decreasing marginal costs. The high fixed costs are associated with 24-hour staffing and the equipment required to accommodate all patient types and a wide range of diagnoses and treatments.

...The marginal costs are the variable costs associated with treating an additional patient.

...more recent research using a large database of hospitals in California found that the marginal cost of an ED visit might actually be quite high, on the order of $300 per visit...which reflect many of the changes that have affected ED financing over the past decade, including greater managed care penetration, increased price competition, and the cost of compliance with EMTALA regulations.

This has led to difficulty in evaluating the fiscal performance of the ED, even if the ED’s presence in the hospital ultimately improves its financial performance. When one considers the additional challenges of
operating a hospital ED —the inability to prescreen patients, the large amount of uncompensated care, declining reimbursements, a
high rate of denials for payment, and the proportion of high-risk patients and associated
malpractice risk— it is easy to understand why the ED might be perceived as a financial liability for the hospital.
"

Pogo is Dead said...

The Financing of Hospital-Based Emergency Departments. . Images

Authors:McConnell, K. John; Gray, David; Lindrooth, Richard C.

Source:Journal of Health Care Finance. Summer2007, Vol. 33 Issue 4, p31-52.

Inga said...

And I neither defended any Dem from calling anyone a cunt or called anyone one, as Drago has been saying all morning long in various places here on Althouse. :)

Centurea said...

Are there too many doctors in Congress?
Asks the Law Prof, knowing that approximately 40-50% of Congresscritters have law degrees. Talk about special interest pleading...

More lawyers in Congress mean more laws that only lawyers can understand (remember that Congressman who professed to be amazed someone expected him to actually read the Obamacare bill?). That means more pay for lawyers--and more deadweight loss for the rest of the economy. Screw that.

Marshal said...

Inga said...
Then I decided you were not to be taken seriously, or perhaps you were simply being contrary


It's always amusing when the person who claimed we have to vote Democrat lest the religious right turn America into The Handmaid's Tale judges who is to be taken seriously. Epic.

Jay said...

Michael K said...

ARM, You accomplished something. You and Inga got me to log onto the physician only website, called Sermo, that I hadn't looked at in years. A quick perusal of the politics segment tells me that physicians, and Sermo has 200,000 subscribers all MD or DO, are not happy with Obama or Obamacare.


SHHHHHHHHHHHHHHHSHUSH!

It is too much fun to pretend, dammit!

Jay said...

Properly implemented there should be a reduction in health care costs by moving these people to primary care physicians.

Yeah, you central planners have a track record of failure that is quite distinguished.

Anyway, nothing, not 1 single thing, about ObamaCare reduces health care spending or costs.

But of course when you're too dumb to see that you can't merely shift "millions" of people to "primary care physicians" just because a law says so, you probably wouldn't know that.

AReasonableMan said...

Ignorance is Bliss said...
Does anyone know why it costs more at an emergency room?


There is endless stuff on this but I can give a personal anecdote. Not that long ago I went to the emergency room because I was really in bad shape after a significant surgery. I knew exactly what was wrong and what I needed. It was a weekend and the surgeon was out of town so I didn't have a lot of options. I spent several hours being given unnecessary procedure after unnecessary procedure. I explained patiently at first and then with increasing frustration that this was all a waste of time. They ignored me. I ended up walking out and making a formal complaint to the hospital. Emergency rooms have no knowledge of the health status or sophistication of the patient and have to use a one size fits all approach that is very wasteful and expensive. To give balance, it is a very difficult environment to provide health care, the typical person can have a very challenging problems and also be clueless. Nonetheless, having wasted hundreds if not thousands of dollars I ended up receiving exactly zero useful health care.

AReasonableMan said...

Revenant said...
How strange that one of the most highly-regulated and highly-subsidized sectors of the economy should be so inefficient and expensive.


For this to be a telling argument you would have to also explain why other countries with much more government control have vastly more efficient systems providing equal or better care.

Pogo is Dead said...

Because most of them are lying. China and Cuba most egregiously, but the West lies, too.

Our government is only just getting started in the healthcare lies it tells.

The NHS in contrast generally seems to be reliable in their numbers, and they do NOT report good ED experiences, nor do they report good cancer or heart care.

'Efficient' is a bullshit word, as well.
What do you mean by it mean exactly, when talking about human beings?

HoodlumDoodlum said...

Empirical question time, I guess:

Will the PPACA increase or decrease emergency room utilization? Bonus points for answering for both the population as a whole and for the previously uninsured.

Michael K said...

"I knew exactly what was wrong and what I needed. It was a weekend and the surgeon was out of town so I didn't have a lot of options."

One option you had was to call the on-call physician for your surgeon. No hospital I have ever been associated with will allow a physician membership on the staff without providing an on-call alternative when he/she is not available.

But don't let me interrupt your pontificating.

sdharms said...

Holy Crap , Ann. What is it with LAWYERS??? That is one of the problems with our laws and Congress today -- too many lawyers in Congress. How about electing someone who has actually WORKED for a living.??

Ignorance is Bliss said...

HoodlumDoodlum said...

Empirical question time, I guess...

Empirical answer time:

Emergency room visits grow in Mass

and

Study: Having Medicaid increases emergency room visits

Michael K said...

"they do NOT report good ED experiences,"

The NHS is notorious for ER waiting times. The NHS then institutes a "four hour rule" that required patients to be seen within 4 hour of arrival. This seems to be a challenge but it was neatly met by making the ambulance wait in the parking lot until the ER was less crowded.

An investigation by The Sunday Telegraph shows that the number of patients forced to wait at least two hours parked outside A&E has risen by two thirds in just one year.
Official figures from eight of England’s ten ambulance trusts show that in 3,424 patients waited more than two hours before “handover” to hospital staff during 2012/13 – compared with 2,061 such patients the year before.


There you go, Inga.

HoodlumDoodlum said...

Ignorance is Bliss said...

Empirical answer time:

Emergency room visits grow in Mass


Gee, I guess the talk about how exepenive and inefficient it is to use emergency rooms for non-emergency care might be a bit misplaced in an argument about how the PPACA will save money and increase efficiency, then.

Pogo is Dead said...

Now that's efficient ED care!

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