A Shortage Of Doctors: Ya Don’t Say… And The Other Unintended Consequences Of Obamacare

Tuesday, April 13th, 2010

The Wall Street Journal shares this inevitable news:

The new federal health-care law has raised the stakes for hospitals and schools already scrambling to train more doctors.

Experts warn there won’t be enough doctors to treat the millions of people newly insured under the law. At current graduation and training rates, the nation could face a shortage of as many as 150,000 doctors in the next 15 years, according to the Association of American Medical Colleges.

That shortfall is predicted despite a push by teaching hospitals and medical schools to boost the number of U.S. doctors, which now totals about 954,000.

The greatest demand will be for primary-care physicians. These general practitioners, internists, family physicians and pediatricians will have a larger role under the new law, coordinating care for each patient.

The U.S. has 352,908 primary-care doctors now, and the college association estimates that 45,000 more will be needed by 2020. But the number of medical-school students entering family medicine fell more than a quarter between 2002 and 2007.

A shortage of primary-care and other physicians could mean more-limited access to health care and longer wait times for patients.

The whole point of health care reform was too feel better–not you, or your health–but liberal politicians.

It wasn’t to improve health care treatment.

It wasn’t to reduce costs.

It wasn’t even to get more people under care.

Wait, what? That’s right. More people will be insured, but patients will receive less care at more cost. It’s just logical. The new health care system creates a gatekeeper system that will eliminate individual choice and drive up costs. So, a person thinks something is wrong with his prostate–he goes directly to a proctologist. That saves 1. wait time 2. cost (no double doctor fees) and 3. diagnosis time.

But not now.

Oh no! Now, a patient must wait to get into an overburdened primary care physician, get a referral and then get into another physician. A patient will be dead by the time he gets diagnosed.

The inevitable response?

Cash-only doctors. Some doctors won’t accept this new insurance and work outside the system. So, people will pay into the health service, hate the waits and then, go pay cash for good care.

The rich will have good care while subsidizing everyone else. The middle class will be caught in a jam because the taxes will be so egregious they can’t afford anything, never mind a quick diagnosis. So they will be caught in government-mandated substandard care.

And the poor, who don’t pay into the system, will still misuse the system because they still won’t take care of themselves. And Medicare and Medicaid could have been expanded to help them as is.

But noooo. An overhaul had to happen. The government had to control health care.

If this diseased legislation doesn’t get revoked, America is going to go down the road of all disastrous socialized countries: chronic unemployment, disheartened and downwardly mobile middle class and an elite aristocracy for whom policy doesn’t matter.

In the liberal world that’s called utopia.

And by the way, a small board will decide what does and does not get covered under Obamacare. So, yes, death sentences will be handed down by the government. That too, is inevitable.



Legislators Legislate. It’s What They Do.

Friday, March 26th, 2010

When I send a patient for a surgical consult, I expect a surgical answer. A surgeon does surgery. It’s what they do. They cut and fix and see the world through the lens of a scalpel. It’s not right or wrong. It just is. You don’t go to a surgeon to sue a business partner or balance your books or invest your money. You don’t go to a surgeon to give you nutritional advice or to solve your relationship trouble. You go to a surgeon for surgery.

I bring up this analogy to explain Congress.

Legislators legislate. They make laws. Their constituents see problems that need solutions. Someone says, “There ought to be a law” and they make a law. Legislators legislate. It’s what they do.

In a sense, there is no “small government” Congressman because their whole purpose is to make laws. And laws, by definition, proscribe behavior. Making laws makes the government bigger and more power and more invasive in your life. This is why they are hated.

Laws, by definition, create lawbreakers. That is, until their is a law on the books, it’s not a crime to do fill-in-the-blank. Because America is drowning in laws, we’re also drowning in criminals. The government, if it were so motivated, has enough legal ammunition to put every American behind bars for something.

So when we hear Representative Paul Ryan praise a Democrat for good parts of the legislation, imagine a surgeon praising another surgeon for his “fine work”.

These guys love to make laws. They love the haggling. They love the collegiality. They love sparring. They LOVE the process. It’s fun to them. It’s like a game.

To some, it IS a game.

Who wins? Who loses? Who bested who? Who out-jousted Representative so-and-so on which morning show. It almost doesn’t matter what the law is about, really. It’s that it’s so damn cool to make a law. And even better, everyone has to do what I say. This is soooo awesome.

When talking to a surgeon friend of mine, he was lamenting the hours and the Medicaid fee reimbursement. I gloated about my free weekends, good hours and happy patients. He said,”But I get to cut.”

So for all the belly-aching you hear from Congressmen, they get to make laws. And laws make your life more constrained, more controlled and less yours. That’s the way it goes.

For fellow Americans expecting salvation from a certain party or group, keep in mind that in order to have the freedom and lack of invasive laws, Congressmen will have to work against their essential nature–making laws. Repealing laws is not a high priority with Congress, if you’ll notice.

Philosophically, they’re belief in the greatness of the individual and the force of that belief will have to outweigh their very human’s bent: to impose their will on someone else. Most of us don’t have the power bend others to our will. Congress has that power. And the power is heady stuff. That’s why there is so many big government Republicans. They wouldn’t be working in government if they didn’t think government was super fantastically great.

All legislators are not to be trusted. Their role is antithetical to freedom. It just is. That’s why there are checks and balances and separation of power, etc. That’s why there are elections.

With legislators spending all their time in Washington, D.C. (Nancy Pelosi loves it that way), they are distant from their constituents, their districts and their states. Their brains marinate in the D.C. power juice and they forget why they’re in DC. Or rather, their mission shifts to pleasing their party masters, big donors, lobbyists, etc. Those people pay the bills, after all.

The only solution is to stick on a Congress person like your life depends on it because these days, it actually does depend on it. And that’s the ultimate problem.

Eventually, the laws get more and more personal, until every aspect of your life is run by the guy who just received your vote.

Vote carefully.



May We Call President Obama A Socialist Now?

Wednesday, March 24th, 2010

I don’t know why Democrats are so touchy about the description. Well, some, like Al Sharpton isn’t. Their motivation is “fairness” which means to take from one person and give to another who hasn’t earned it. From the New York Times:

A big chunk of the money to pay for the bill comes from lifting payroll taxes on households making more than $250,000. On average, the annual tax bill for households making more than $1 million a year will rise by $46,000 in 2013, according to the Tax Policy Center, a Washington research group. Another major piece of financing would cut Medicare subsidies for private insurers, ultimately affecting their executives and shareholders.

The benefits, meanwhile, flow mostly to households making less than four times the poverty level — $88,200 for a family of four people. Those without insurance in this group will become eligible to receive subsidies or to join Medicaid. (Many of the poor are already covered by Medicaid.) Insurance costs are also likely to drop for higher-income workers at small companies.

Finally, the bill will also reduce a different kind of inequality. In the broadest sense, insurance is meant to spread the costs of an individual’s misfortune — illness, death, fire, flood — across society. Since the late 1970s, though, the share of Americans with health insurance has shrunk. As a result, the gap between the economic well-being of the sick and the healthy has been growing, at virtually every level of the income distribution.

The health reform bill will reverse that trend. By 2019, 95 percent of people are projected to be covered, up from 85 percent today (and about 90 percent in the late 1970s). Even affluent families ineligible for subsidies will benefit if they lose their insurance, by being able to buy a plan that can no longer charge more for pre-existing conditions. In effect, healthy families will be picking up most of the bill — and their insurance will be somewhat more expensive than it otherwise would have been.

Each according to his need. Enforced fairness.

What is the natural consequence of such actions? The rich make sure they are no longer rich. By any means necessary, they will make sure their income falls below the taxation threshold. A whole new industry will pop up to help rich people. And rich people will go buy health care somewhere else. They can afford to travel to Mexico after all, to get cheaper health care. And the cost of health care in America will rise from this legislation.

And then, the government will have to force people to pay more taxes, which is why the President is considering a VAT tax. This whole issue will spiral. Costs will increase, tax revenue will decline. The black market for everything will flourish.

The incentives are all wrong. Why should people quit smoking and eat right? Pay the fine for not having insurance and then buy insurance when you get sick.

Socialism never works because it fundamentally operates against human nature. It reinforces bad behavior and extinguishes good behavior.

But it’s “fair.”



Obamacare Won’t Be Repealed, But It Will Make Americans Hate Democrats

Tuesday, March 23rd, 2010

My not-so-cheery thoughts on Obamacare from over at Pajamas Media:

Meanwhile, Americans are stuck with what the Democrats have wrought. And much as they hate the policy rape, they’ll come to identify with their captors soon enough.

Why? It’s human nature.

First, no one will allow Congress to repeal a law that would take away health care “for the children.” Not even the toughest Republican wants to have that conversation with a crying constituent. So it won’t happen. So all the talk of “repeal it” is hopeful hokum.

Second, there are Medicare cuts in the bill. The country is going down the economic crapper and cannot afford the current Medicare and Medicaid obligations, so the cuts and the bill stay.

Third, when people pay huge taxes and then get nothing for it, they know the taxes won’t go away so they complain about the product. That’s what will happen here.

Now, this bill will change everyone’s life for the worse, so there’s that happy thought. Happy? Well, American citizens from young to old will curse the Democrats.

The young people will be furious because when they voted for Obama with unicorn dreams, they didn’t imagine having to actually pay for health care with money that could be used to buy beer. Dude just harshed their mellow.

Old people will be angry because if there is one group of people who hold on to their entitlements with boney, clingy fingers, it’s old people. So with the new health care bill, they get more free drugs but they have to pay for so much else. They won’t be happy.

Small business owners will be more disheartened. We’re in a recession, remember? Yeah, these companies are barely holding on during these tough times, trying to not fire people or lay them off. Now, they have to add health care costs. Guess what? There will suddenly be many more companies with 49 employees. Are you in a company of 60 people where health insurance isn’t provided? Uh-oh. Watch out.

Doctors will stop taking Medicare and Medicaid patients. I already don’t. In protest, doctors across America will simply refuse to accept any government plan. Chaos will ensue. Old people will be hit hardest.

So yes, people are ticked off. Irate even. The Democrats don’t care and the American people are helpless to do anything except pour money into Republican candidates.

And that brings us to the Republicans. Reversing this travesty depends on them. These are the guys bandying about immigration reform and who routinely get lost in the weeds. Will the rage the American people are displaying help them keep their focus? Maybe.

It’s distressing putting my hope in any politician’s will to act nobly. It’s not in the job description. Politicians, even the fresh, green, idealistic politicians who will be elected in November, get polluted almost immediately. They start listening to “advisers” and the more seasoned pros. They start doing what legislators do: make laws. And laws, by definition, impinge on rights. That’s the way it works.

So no, I don’t believe health care will go away. I believe it will divide us, create chaos, and turn the conversation away from big dreams and freedom to provincial “my piece of the pie” talk.

Health care “reform” makes America small. That’s just the way Democrats like it.

Please don’t think I feel totally hopeless. I don’t. The bill can be gutted and dismantled. But can it be repealed? Doubtful. Is the fight over? No.

But this bill irrevocably changed America, there’s no denying it. And it changes America for the worse.

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What Have Democrats Wrought?

Monday, March 22nd, 2010

The Democrats have wrought a mess: Confusion. Chaos. Strife. Division. Rage.

And they love it.

States are already readying suits over the constitutionality. Citizens are up in metaphorical arms. Senators are drawing lines:

GOP senators emerged Monday to warn that the health debate had taken a toll on the institution, and warning of little work between parties the rest of this year.

“There will be no cooperation for the rest of the year,” McCain said during an interview Monday on an Arizona radio affiliate. “They have poisoned the well in what they’ve done and how they’ve done it.”

President will revel in his transient approval numbers bump and then he will will revel in the chaos all over the country.

Meanwhile, guess who wins? The insurance companies the Obama administration is in bed with, that’s who:

And the economic effects will also take quite some time to play out.

But the early reading from Wall Street seems to be that the health care industry, particularly the insurers, will be all right:

— “Health insurers’ stocks rose in opening trading Monday, while the broader market slipped,” Reuters says. ” Large insurers WellPoint Inc and UnitedHealth Group rose slightly, while insurers such as Amerigroup and Molina Healthcare that focus on Medicaid plans for low-income Americans climbed sharply.”

— “The Dow’s pharmaceutical components were among the very few stocks in the black on Monday, as drug-makers are expected to profit from the expansion of health-care coverage. Merck (MRK) rose 0.3%, while Pfizer (PFE) climbed 1.1%.” (The Wall Street Journal)

— “U.S. stocks fluctuated as health- care companies advanced after the House passed an overhaul of the industry, while commodity producers retreated amid concern growing government debt will stifle the economic recovery. Merck & Co. and Pfizer Inc. helped lead health-care companies to the biggest gain among 10 groups in the S&P 500 after the House approved legislation that will ensure tens of millions of uninsured Americans will get medical coverage.” (Bloomberg News)

So, basically, the Democrats have a created a mess for the American people and reward those they vilified. All in a days work.

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