Wintery Knight

…integrating Christian faith and knowledge in the public square

NHS appeals decision allowing midwives to conscientiously object to performing abortions

What happens when you let a secular government take over health care provisioning?

Here is a story from the BBC about the state-run health care system in the UK.

Excerpt:

The UK’s highest court will hear legal arguments on whether midwives have a right to refuse to take any part in abortion procedures on moral grounds.

NHS Greater Glasgow and Clyde appealed to the Supreme Court after judges in Scotland said Roman Catholic midwives had a right to conscientious objection.

[…]Five judges in London will hear the case. A ruling is expected next year.

Ms Doogan, from Garrowhill in Glasgow, and Mrs Wood, from Clarkston in East Renfrewshire, were employed as labour ward co-ordinators at the Southern General Hospital in Glasgow.

[…]This landmark case tests the balance between those whose religious beliefs do not allow them to play any part whatsoever in abortion, and the health authorities’ duty under the law to enable women to have an abortion. Many Christian groups back the midwives’ position.

The midwives’ counsel, Gerry Moynihan QC, told the court in the women’s earlier successful appeal that the law was clear that the right to conscientious objection contained in the Abortion Act was intended to apply to the whole team whose involvement was necessary to achieve the procedure.

If the Supreme Court upholds the midwives’ earlier successful appeal, it could set a legal precedent, allowing other midwives who object to abortion to take the same stance.

The Royal College of Midwives and the women’s charity British Pregnancy Advisory Service have both warned that any such ruling could have severe implications for the care of women choosing to terminate their pregnancy.

The BPAS is the largest abortion provider in the UK. I blogged before about their leader, Ann Furedi, who supports sex-selection abortions. I thought then that sex-selection abortions was the worst thing about abortion, but now I see that she would actually force her moral views on other people, compelling them by the power of government to act against their beliefs. There is something deep inside me that just recoils from making a person do something that they think is morally wrong. But I guess pro-abortion people don’t share my concern.

When I blogged before about these two midwives when they won their appeal case, I wrote this:

If the health care system were private, then it would be easy for midwives to find another company to work for that did not violate their consciences. But when the government runs the whole health care system, where are you supposed to go? They are a monopoly and they make the rules. Yet another reasons for Christians to vote for smaller government. In a free market, if you don’t want to buy something from one store, you can go to another store. There is competition. But where are these nurses supposed to go? They are midwives, and the government and the courts make the rules in a government-run health care system.

This is why we need to keep the government OUT of health care. When you work for a government monopoly, and they want you to do something that you don’t want to do, you have two choices – do what they want or leave the country. If the only health care system is government-run, then if you want to practice health care, you have to leave. That seems unfair to me.

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White House review of VA finds “corrosive culture” to blame for poor patient care

The Wall Street Journal reports.

Excerpt:

A White House review of the VA health system points to a culture that has degraded the timely delivery of care and requires a restructuring to improve transparency and accountability.

Acting Secretary of Veterans Affairs Sloan Gibson and Rob Nabors, White House deputy chief of staff, told President Barack Obama on Friday that significant further action was needed to address systemic problems.

Six weeks after the president dispatched Mr. Nabors to assess problems within the VA, the president’s aide outlined a long list of issues affecting access to timely care at VA medical facilities.

Mr. Nabors’s work is the latest in a series of reviews and reports issued in the past two months, including those from the VA’s independent inspector general, the Office of the Special Counsel and the VA itself. The new report found what Mr. Nabors described as a “corrosive culture” that affects employee performance and patient care. He added that the Veterans Health Administration structure has “impeded appropriate management, supervision and oversight.”

The review also found that the VA’s goal for scheduling many medical appointments within 14 days is “arbitrary, ill-defined and misunderstood.” That goal had been set in 2011. The VA recently eliminated that 14-day target.

Mr. Gibson praised the report. “We know that unacceptable, systemic problems and cultural issues within our health system prevent veterans from receiving timely care,” he said in a statement.

The White House has scrambled to respond to evidence of widespread mismanagement within the VA and to fill a growing number of vacancies in top posts. An internal assessment also revealed improper appointment-scheduling procedures and efforts to hide long wait times across the VA health system.

Another interim report from the VA inspector general confirms that:

The VA’s independent inspector general office has said it would likely issue in August its full report on its sweeping review of the department. An interim report, issued just days before Mr. Shinseki’s resignation, showed problems throughout the VA. They included employees tinkering with official patient appointment wait times to make them seem much shorter than the actual times veterans were having to wait.

In case you were wondering why this is all happening in the VA health care system and not in the private health care system, it’s because the VA is 100% pure government-run health care, as health care expert Avik Roy explains in Forbes magazine. The VA is not scandal is not some sort of aberration from government-run health care. Long wait times and patient deaths are essential to government run health care, in practice.

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How do doctors feel about the federal government’s regulation of their profession?

In the Wall Street Journal, a doctor speaks out about government control of health care.

Excerpt:

In my 23 years as a practicing physician, I’ve learned that the only thing that matters is the doctor-patient relationship. How we interact and treat our patients is the practice of medicine. I acknowledge that there is a problem with the rising cost of health care, but there is also a problem when the individual physician in the trenches does not have a voice in the debate and is being told what to do and how to do it.

[…]The Centers for Medicare and Medicaid Services dictates that we must use an electronic health record (EHR) or be penalized with lower reimbursements in the future. There are “meaningful use” criteria whereby the Centers for Medicare and Medicaid Services tells us as physicians what we need to include in the electronic health record or we will not be subsidized the cost of converting to the electronic system and we will be penalized by lower reimbursements. Across the country, doctors waste precious time filling in unnecessary electronic-record fields just to satisfy a regulatory measure. I personally spend two hours a day dictating and documenting electronic health records just so I can be paid and not face a government audit. Is that the best use of time for a highly trained surgical specialist?

This is not a unique complaint. A study commissioned by the American Medical Association last year and conducted by the RAND Corp. found that “Poor EHR usability, time-consuming data entry, interference with face-to-face patient care, inefficient and less fulfilling work content, inability to exchange health information between EHR products, and degradation of clinical documentation were prominent sources of professional dissatisfaction.”

In addition to the burden of mandated electronic-record entry, doctors also face board recertification in the various medical specialties that has become time-consuming, expensive, imposing and a convenient method for our specialty societies and boards to make money.

Meanwhile, our Medicare and Medicaid reimbursements have significantly declined, let alone kept up with inflation. In orthopedic surgery, for example, Medicare reimbursement for a total knee replacement decreased by about 68% between 1992 and 2010, based on the value of 1992 dollars. How can this be? Don’t doctors have control over what they charge for their services? For the most part, no. Our medical documentation is pored over and insurers and government then determine the appropriate level of reimbursement.

I don’t know about other physicians but I am tired—tired of the mandates, tired of outside interference, tired of anything that unnecessarily interferes with the way I practice medicine. No other profession would put up with this kind of scrutiny and coercion from outside forces. The legal profession would not. The labor unions would not. We as physicians continue to plod along and take care of our patients while those on the outside continue to intrude and interfere with the practice of medicine.

We could change the paradigm. We could as a group elect not to take any insurance, not to accept Medicare—many doctors are already taking these steps—and not to roll over time and time again. We have let nearly everyone trespass on the practice of medicine. Are we better for it? Has it improved quality? Do we have more of a voice at the table or less? Are we as physicians happier or more disgruntled then two years ago? Five years ago? Ten years ago?

Doctors certainly provide a lot more value to me than unions, lawyers and government workers of all sorts. I wish we had more doctors, and fewer unions, lawyers and government workers. Anything that doctors can do to push back against their tormentors would be welcome in my opinion.

 

Filed under: News, , ,

Doctor shortage: how Obamacare makes it harder to find a doctor

Remember how Obama promised that if you liked your doctor, then you could keep your doctor? It turns out that there is more to making policies than just saying what you’d like to do in a scripted campaign speech. The truth is that some health care policies will make you lose your doctor, regardless of what the President reads off of a teleprompter. Is Obamacare one of these policies? Let’s see.

Avik Roy writes about it in Forbes magazine.

Excerpt:

On Saturday, the Wall Street Journal reported that, due to Obamacare’s cuts to Medicare Advantage, among other factors, UnitedHealth expects its network of physicians “to be 85 percent to 90 percent of its current size by the end of 2014.” The result? Some retirees enrolled in Medicare Advantage will need to find new doctors. And it’s a trend that could accelerate in future years.

[…]Over the next ten years, Obamacare was designed to spend around $1.9 trillion on expanding health coverage to the uninsured. The law pays for this new spending with $1.2 trillion in new taxes, and $716 billion in cuts to Medicare, relative to prior law.

[…]The private insurers who supply Medicare Advantage plans, like UnitedHealth and Humana, have been responding to the cuts by squeezing out inefficiencies in the way they deliver care. One obvious way to do that is to pay doctors and hospitals less—or kick out the providers who refuse to accept lower reimbursement rates. And that’s what United has done, according to the WSJ report from Melinda Beck.

“Doctors in at least 10 states have received termination letters, some citing ‘significant changes and pressures in the health-care environment,’” writes Beck.

Another one of my favorite health care policy experts is the ex-Canadian Sally C. Pipes, who knows all about the horrors of single-payer health care. It killed her mother! Here’s what she had to say about the doctors shortage in a Forbes magazine article from earlier this year.

The first problem is that we have an aging doctor population and since we do such a poor job of educating our children (public school indoctrination centers) we aren’t making any new ones:

Right now, the United States is short some 20,000 doctors, according to the Association of American Medical Colleges. The shortage could quintuple over the next decade, thanks to the aging of the American population — and the aging and consequent retirement of many physicians. Nearly half of the 800,000-plus doctors in the United States are over the age of 50.

The second problem is that adding more regulations and burdensome paperwork makes a lot of people not want to be doctors any more:

Obamacare is further thinning the doctor corps. A Physicians Foundation survey of 13,000 doctors found that 60 percent of doctors would retire today if they could, up from 45 percent before the law passed.

The third problem is that the government isn’t reimbursing doctors as much as private insurance companies do, and it makes them refuse to take government-funded patients:

They’ve long limited the number of Medicaid patients they’ll treat, thanks to the program’s low reimbursement rates. According to a study published in Health Affairs, only 69 percent of doctors accepted new Medicaid patients in 2011. In Florida, just 59 percent do so. And a survey by the Texas Medical Association of doctors in the Lone Star State found that 68 percent either limit or refuse to take new Medicaid patients.

Medicaid pays about 60 percent as much as private insurance. For many doctors, the costs of treating someone on Medicaid are higher than what the government will pay them.

These underpayments have grown worse over time, as cash-strapped states have tried to rein in spending on Medicaid. Ohio hasn’t increased payments to doctors in three years; Kentucky hasn’t raised them in two decades. Colorado, Nebraska, South Carolina, Arizona, Oregon, and Arizona all cut payments in 2011.

By throwing nine million more people into the program without fixing this fatal flaw, Obamacare will make it even harder for Medicaid patients to find doctors.

It’s not just Medicaid that’s the problem, either. It’s the government-controlled exchanges.

Healthcare providers are signaling that they may turn away patients who purchase insurance through the exchanges, too.

In California, for example, folks covered by Blue Shield’s exchange plan will have access to about a third of its physician network. The UCLA Medical Center and its doctors are available to customers of just one plan for sale through the state exchange, Covered California. And the prestigious Cedars-Sinai Medical Center is not taking anyone with exchange insurance.

Now I know what you’re thinking – why not just force doctors to work for lower wages, like a good socialist country might? Well, that actually makes the shortage worse, because people don’t like to learn hard things and then work hard for little pay. And doctors work VERY hard – it’s not an easy profession to get into. That will just make all the doctors leave the country for other countries where they can be paid fairly for the work they do.

And in fact that is exactly what happened in a 100% socialized health care system in Venezuela, according to this report from the left-leaning Associated Press.

Excerpt:

Half the public health system’s doctors quit under Chavez, and half of those moved abroad, Natera said.

Now, support staff is leaving, too, victim of a wage crunch as wages across the economy fail to keep up with inflation.

At the Caracas blood bank, Lopez said 62 nurses have quit so far this year along with half the lab staff. It now can take donations only on weekday mornings.

I recommend reading that entire article for a glimpse of where the Democrats are trying to take us. There is not a dime’s worth of difference on policy between the Democrat party and the socialist party of Venezuela, except that the socialists have been in control in Venezuela for longer, and so they are further along the road to serfdom.

In other news, the Washington D.C. insurance commissioner was fired after raising concerns about the “fix” proposed by Obama in his speech last week. That’s also something that you might expect to see in a country like Venezuela. That’s what happens in authoritarian socialist countries. Whistleblowers and critics just disappear.

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Duke U. researcher: 129 million people will lose health insurance under Obamacare

From the Daily Caller.

Excerpt:

If Obamacare is fully implemented, 68 percent of Americans with private health insurance will not be able to keep their plan, according to health care economist Christopher Conover.

Conover is a research scholar in the Center for Health Policy & Inequalities Research at Duke University and an adjunct scholar at the American Enterprise Institute. In an interview with The Daily Caller, he laid out what he estimates the consequences of Obamacare’s implementation will ultimately be.

“Bottom line: of the 189 million Americans with private health insurance coverage, I estimate that if Obamacare is fully implemented, at least 129 million (68 percent) will not be able to keep their previous health care plan either because they already have lost or will lose that coverage by the end of 2014,” he said in an email. ”But of these, ‘only’ the 18 to 50 million will literally lose coverage, i.e., have their plans entirely taken away. This includes 9.2-15.4 million in the non-group market and 9-35 million in the employer-based market. The rest will retain their old plans but have to pay higher rates for Obamacare-mandated bells and whistles.”

Conover also says it is hard to imagine President Obama didn’t know these statistics when he was flacking for his health care bill by promising Americans they could keep their health insurance if they liked it.

“If President Obama himself believed this the first time he said it, he was poorly advised,” Conover said.

“The problem is that he said it at least 24 times, most of which occurred after his own rule-writers had estimated that 49-80 percent of small employer plans would have lost their grandfather status by 2013, along with 34-64 percent of large employer plans. The same rule estimated that each year 40 to 67 percent of non-group plans not already grandfathered would lose their grandfather status. Given how extensively presidential statements — especially to a joint session of Congress — are vetted and fact-checked, it is pretty inconceivable that President Obama was not aware that he was engaged in some degree of truth-twisting.”

Surprise! It looks like what the Democrats wanted was to destroy private health insurance, after all. The nice thing about this is that finally the low-information voters who elected Obama are getting to see why it might be a good idea to get their political news from somewhere other than the Comedy Channel.

Filed under: News, , , , , , ,

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