Wintery Knight

…integrating Christian faith and knowledge in the public square

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.

Filed under: News, , , , , , , , , , , , , , , , , , , , , , , , ,

Americans choosing not to purchase Obamacare exchange plans

On Fox News Sunday, Brit Hume talked about how the majority of the new enrollees are signing up for Medicaid, not Obamacare, and how young people are refusing to sign up for Obamacare plans on the exchanges.

And more discussion from the same panel:

For those who can’t watch, here’s an article from Fox News about how the majority of new enrollees are choosing Medicaid, not Obamacare plans.

Excerpt:

While virtually all the ObamaCare focus is trained on the program’s dysfunctional website, another problem could be emerging — in states where individuals are able to sign up, far more are enrolling in Medicaid than private plans.

For now, the statistics are spotty. The Obama administration still hasn’t provided figures on how many people have successfully enrolled through the federally run exchanges. Some, but not all, states have provided their own relatively up-to-date figures.

But for those that have, the lopsided numbers show Medicaid is getting the lion’s share of enrollees.

In Washington state, more than 35,000 people have signed up for coverage since Oct. 1. Of them, just 4,500 went into private plans. Roughly 31,000 signed up for Medicaid — with coverage kicking in sometime between now and Jan. 1.

The director of the state’s Health Care Authority said they were “pleased by the strong response of Medicaid-eligible residents.”

But the imbalance — if it does not even out in the months to come — could create problems for private insurance companies which are relying on a major influx of new and healthy customers to make the system hum.

“There are a lot of elements of this law that have to work, that must work — otherwise the whole thing collapses,” the Cato Institute’s Michael Cannon said. “They need — need — lots of healthy people to sign up for insurance through the exchanges.”

The fact that people are flocking to Medicaid isn’t necessarily a problem — but a lack of healthy enrollees on private plans would be.

The main reason the Affordable Care Act mandated that individuals buy insurance was so that private insurers would get enough young, healthy people in the system who could offset the costs of covering older and sicker patients. Otherwise, at the very least, costs will skyrocket for those in the system.

[...]The Democrat and Chronicle newspaper reports that in New York, nearly 24,000 of the 37,000 newly enrolled residents are going into Medicaid, which millions of New Yorkers are already on. Just 13,313 chose private plans.

Medicaid is fully taxpayer-funded, so this is not going to help the deficit/debt situation at all. That money will have to be borrowed and paid back by taxpayers. Making things worse is the fact that young people are not signing up to purchase the overpriced health insurance plans on Obamacare exchanges.

Excerpt:

As Nick Gillespie and Veronique de Rugy have pointed out for Reason magazine, the concept of today’s older generation as impoverished is simply wrong. In fact, today’s seniors are far wealthier than today’s young adults.

Looking at rates of homeownership, 83% of elderly households own a home. Meanwhile, 36% of millennials are still living under their parents’ roof. Those over 65 years of age have much lower poverty rates than most other demographic groups. Households headed by people 65 or older have 22 times the wealth of households headed by people under 35.

Not only are many young people either unemployed or underemployed, the Consumer Financial Protection Bureau estimates that people under 40 owe 67% of the roughly $1.4 trillion that Americans owe on school loans. That’s on top of an average of several thousand dollars of credit card debt.

ObamaCare forces people who can scarcely afford the extra cost to subsidize care for people who absolutely can afford to pay for their own health services.

In the exchanges, a young person will have to pay an estimated $250 per month for basic insurance. Again, this cost is so high because these premiums are expected to pay for older people’s healthcare costs. These costs now include covering a plethora of expensive drugs, services and procedures thanks to ObamaCare’s requirements for insurance plans.

Buying plans on insurance exchanges costs money, and many young people don’t have any money to spend these days. Young people have not done particularly well at finding jobs lately, especially since they have acquired precious few marketable skills in the public schools. (Most people can’t get a job calling people racist and sexist and homophobic, because there are only so many journalism jobs to go around).

So what Obama has really done is promised lots of goodies to all of his supporters, but there is no one signing on to pay for it. And that’s what I would expect from someone with no marketable degrees or skills who has very very limited experience working in the private sector. Many of the people in the Obama administration just haven’t done anything productive in the private sector, and that lack of experience is now showing. We have elected a government that believes in making policy based on feelings, not facts.

Filed under: News, , , , , , ,

New study from the Federal Reserve finds that QE stimulus doesn’t grow the economy

Investors Business Daily reports on our incompetent government’s policies.

Excerpt:

For four years now, we’ve heard policymakers and pundits alike defend the Federal Reserve’s quantitative easing based on the idea that, without it, the nation’s economy would have imploded.

Now, a new study from the Fed itself suggests that’s not the case.

The study, by San Francisco Federal Reserve economist Vasco Curdia and New York Fed economist Andrea Ferrero, suggests that quantitative easing (QE) has done little to boost the economy’s trajectory.

“Asset purchase programs like QE2 appear to have, at best, moderate effects on economic growth and inflation,” the economists wrote in a special research note that was released last week.

In their study, Curdia and Ferrero looked specifically at the impact of the Fed’s QE2 program, which totaled $600 billion.

Assuming the $600 billion program lasts for five years — with the Fed buying bonds the first year, holding them for two, then selling them off for the remaining two — the spending turns out largely to have been a waste.

That level of QE stimulus, even when coupled with the Fed’s promise to hold interest rates at zero, likely boosted GDP by a mere 0.13 percentage point, the study found. It added just 0.03 percentage point to inflation.

Bottom line: $600 billion in QE2 spending boosted GDP by less than $200 billion.

[...]And even that minor amount of growth was due in large part to the Fed’s explicit vow to hold official interest rates at close to 0% until the unemployment rate reaches 6.5% or lower, Curdia and Ferrero said.

Take away that promise, and QE2 added just 0.04 percentage point to GDP and 0.02 percentage point to inflation.

What caused it?

With $17 trillion in total U.S. debt — an amount that’s now growing at a rate of $1 trillion a year — the authors argue that the Fed is essentially trapped into printing money through QE.

If QE — which now pushes $85 billion a month into U.S. Treasury and agency debt — stops, interest rates will soar, dragging the economy down.

Fed Chairman Ben Bernanke has been sanguine about this, suggesting this enormous pile of debt can all be sold off with little disruption.

We’re not so sure. Once the Fed begins selling off its massive $3.6 trillion in assets acquired under the QE program (see chart), it will send interest rates surging and tank the economy.

Even more troubling is what it says about current politics.

The White House and a Democrat-led Senate have boosted spending dramatically — outlays as a share of GDP rose initially by 25% under President Obama

The Fed, by buying up much of the newly issued federal debt, has become the No. 1 enabler of a spendthrift government that’s pushing us to the brink of fiscal disaster.

At $85 billion a month, QE2 spending is roughly equal to the amount of federal debt we add each month.

We elected a Keynesian who thought that government could create economic growth (jobs!) by borrowing money and printing money. The countries of the world largely cheered our decision to elect him. He failed to grow the economy and he failed to create jobs. Eventually, the money he’s been spending to keep a sinking ship afloat is going to run out.

Filed under: News, , , , , , , , , , , , , , , , , , , , ,

Planned Parenthood must pay $1.4 million in Medicaid fraud settlement

The Heritage Foundation reports.

Excerpt:

Planned Parenthood Gulf Coast, which serves southeast Texas and Louisiana, agreed this week to pay $1.4 million to the state of Texas, settling claims that one of the largest abortion providers in the Southeast had fraudulently overbilled the state’s Medicaid program.

Texas Attorney General Greg Abbott’s office stated that its investigation into the fraud allegations “revealed that Planned Parenthood Gulf Coast improperly billed the Texas Medicaid program for products and services that were never actually rendered, not medically necessary, and were not covered by the Medicaid program.”

The Texas Planned Parenthood allegedly “falsified material information in patients’ medical records” to bolster fraudulent claims for reimbursement.

Alliance Defending Freedom’s recent analysis of state and federal audits of family planning programs suggests that in 12 states, Planned Parenthood affiliates overbilled Medicaid for more than $8 million. One federal audit of New York’s Medicaid family planning program reported that certain providers, “especially Planned Parenthoods,” had engaged in improper practices resulting in overpayment.

Despite mounting accusations of fraud, the organization that performs roughly one out of every four abortions in the U.S. has continued to ride the waves of taxpayer funding to annual surpluses. During its last reporting year alone, Planned Parenthood received over half a billion dollars in taxpayer government funding, all the while performing a record 333,964 abortions. To solidify its place as the top abortion provider in the country, Planned Parenthood announced that all local affiliates would have to begin providing abortion services starting in 2013.

A one million dollar fine doesn’t seem like much, compared to over $500 million in taxpayer subsidies. But it’s a start. Abortion is a for-profit business. If we make abortion unprofitable, then abortion will go away.

Related posts

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Can we fix poverty by redistributing money, or is the problem something else?

This little blurb by a doctor is making the rounds on Facebook:

Dear Mr. President:

During my shift in the Emergency Room last night, I had the pleasure of evaluating a patient whose smile revealed an expensive Shiny gold tooth, whose body was adorned with a wide assortment of elaborate and costly tattoos, who wore a very expensive brand of tennis shoes and who chatted on a new cellular telephone equipped with a popular R&B ringtone.

While glancing over her Patient chart, I happened to notice that her payer status was listed as “Medicaid”! During my examination of her, the patient informed me that she smokes more than one costly pack of cigarettes every day and somehow still has money to buy pretzels and beer.

And, you and our Congress expect me to pay for this woman’s health care?

I contend that our nation’s “health care crisis” is not the result of a shortage of quality hospitals, doctors or nurses. Rather, it is the result of a “crisis of culture”, a culture in which it is perfectly acceptable to spend money on luxuries and vices while refusing to take care of one’s self or, heaven forbid, purchase health insurance.

It is a culture based on the irresponsible credo that “I can do whatever I want to because someone else will always take care of me”. Once you fix this “culture crisis” that rewards irresponsibility and dependency, you’ll be amazed at how quickly our nation’s health care difficulties will disappear.

Respectfully,
STARNER JONES, MD

My first reaction to this thing was HOAX, but Snopes says it’s not a hoax. In fact, it was a letter published in a newspaper.

And there was even a follow-up letter by the same doctor:

I continue to receive numerous phone calls, letters, emails and face-to-face comments about my letter (“Why Pay For the Care of the Careless”) which appeared in your newspaper a few months ago.

Most people express highest approval for the opinion set forth. Indeed, the truth has an illuminating quality all its own.

However, a few have disagreed and all of them falsely assume that a person who holds the views which I espouse must have been raised in a privileged home. Nothing could be further from the truth.

I grew up in a lower middle class, single parent home in the rural hill country of Pontotoc, Mississippi. While attending public schools, I paid attention in class and did my homework. I ran with the right crowd and stayed out of trouble. My dedication in school resulted in a full-paid scholarship to the prestigious University of the South in Sewanee, TN. After college, I left to go to medical school with everything I owned in three bags. The rest is history.

Motivation, not entitlement, is the key to personal success and happiness in life.

The fact of the matter is that it is often people who have come out of poverty themselves who most disagree with those who want to keep people in poverty by subsidizing their poor decision making. I come from a background where my parents were immigrants and my father worked 3 jobs and my mother worked one. We saw people around us who were poor like us, making these irresponsible spending decisions and they were encouraged to persist in it by welfare programs like Medicaid. They were getting tens of thousands of dollars in benefits, and they would lose those benefits if they worked their way out of poverty.

The fact of the matter is that we are doing the able-bodied non-working poor no favors by allowing them to persist in the worldview of poverty, which is encourages dependence, recklessness, consumption and waste. Eventually, the state runs out of other people’s money to subsidize the able-bodied non-working poor in their perpetual childhood, and then where will they be? We are already $16.5 trillion in debt, and this level of welfare spending is not sustainable. Eventually, they will have to fend for themselves. We will be leaving them uneducated, with no resume, and a host of addictions ranging from the lottery and cigarettes up to drugs and alcohol.

Instead of fretting over feelings, and worrying about being judgmental, we should be fretting about enacting policies that promote marriage, school choice, entrepreneurship, work and so on. Strengthening the family and rewarding hard work. If the concern is that health care costs too much, there are ways to lower the cost of health care with market-oriented reforms. We should be studying the economics of health care and promoting consumer choice, ownership and competition among health care providers. Government is not the answer.

I really recommend that everyone read a book by British doctor Theodore Dalrymple, who gives a close-up view of what government programs actually do to the people we would all like to help. I have linked to all the chapters here, so there is no excuse not to read it and get informed. Then we can read other books on consumer-driven health care in order to learn about how to reduce the cost of health care without growing government.

Filed under: Commentary, , , , , , , ,

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