Wintery Knight

…integrating Christian faith and knowledge in the public square

Sally Pipes: how Obamacare causes doctors to quit practicing medicine

Sally C. Pipes is one of my favorite health care policy analysts. She has written several books on topics like the Canadian health care system, the American health care system, and the Obamacare health care law. She has debated health care with that damnable leftist Paul Krugman, among others. She heads up a think tank based in San Francisco, CA called the Pacific Research Institute.

Here is her latest column in the Orange County Register.

Excerpt:

Thanks to Obamacare, America’s corps of doctors appears to have a case of the blues.

The Physicians Foundation recently asked more than 13,000 doctors about their morale, their career plans, their practices and their views of the Affordable Care Act. The results were grim.

Nearly six in 10 doctors said that they are less positive about the future of health care in America under Obamacare. Almost two-thirds have a negative attitude toward their jobs – nearly twice as many as before the health law was passed in 2010.

As a result, many doctors are cutting back on their workload or shuttering their practices. Worse, their collective frustration is exacerbating our nation’s troubling doctor shortage.

More than three-fifths of doctors say they would retire today if they could, compared with 45 percent before Obamacare. Eighty-four percent say the medical profession is in decline. Fewer doctors say they would enter the profession today if they had it to do over again, and fewer would recommend it to their children.

This decline in doctors’ morale is taking a toll on Americans’ ability to access care. Physicians report working almost 6 percent fewer hours than they did four years ago. That’s about two and a half hours less per week per doctor. Add up all the hours, and it’s the equivalent of losing more than 44,000 full-time physicians.

Doctors also report seeing some 16 percent fewer patients than they did in 2008. That represents tens of millions fewer doctor-patient encounters each year.

More than half those surveyed say they plan to cut back further on the time they devote to patient care, to work part time, to retire or to switch to direct-pay “concierge”-type medical practices, which are beyond the reach of many of Obamacare’s rules and regulations.

Even before the law, America faced a chronic doctor shortage, with a gap of 14,000 physicians in 2010. And the problem will only grow worse.

According to the Association of American Medical Colleges, Obamacare will push the doctor shortage up to 63,000 by 2015 – and more than 91,000 by 2020. That’s in addition to the full-time-equivalent losses from doctors working fewer hours.

I have been talking to people in my office who voted for Obama all week to see why they did what they did. Surprisingly, not many people I talked to voted for him. But for those that did, a popular reason is that they wanted to tax the rich more. I asked them what would happen if you taxed the rich more. They told me that Obama can tax people who are “rich” more and more and that the “rich” will just keep paying those higher taxes while still continuing to work and work to provide the goods and services that we all use. I asked them about regulations, and they said that Obama can just keep heaping burdensome regulations on these “rich” people more and more, and they won’t mind at all. They’ll just keep working and hiring people and providing goods and services even if they make less money and have to work more to comply with regulations.

One of the Indian contractors who voted for Obama told me that rich people do what they do because they like it, and they will keep doing it no matter how much we tax and regulate them. “They will do it for love of fairness, and because Obama is such a good man – they will be inspired by him to pay the higher taxes and to fill in the extra paperwork”, he told me. For him, people just do whatever they like. The reason why some people work is because they like working, and the reason why some people don’t work is because they like not working. Another Obama-voter told me that people should be able to do whatever they like and everyone should end up equal in the end. Some people will work because they like to, and others won’t. Taxes don’t affect what a person does. Nor does the difficulty of the work. Nor does the exposure to malpractice lawsuits.  Nor does the higher medical insurance premiums. Doctors do what they do because they like it, and the conditions and profit margins don’t matter. Rich people like doctors will keep working at whatever they do even if they are taxed so much that they earn the same amount of money as people who work at McDonald’s.

That’s the worldview of the people who voted for Obama. They don’t understand incentives at all. They don’t understand the profit motive. They think that people who go to medical school until they are 35, racking up tens of thousands of dollars in debt in the process, will be happy to work 80 hour weeks and to pay 50% of their income in taxes so that other people can have free contraceptives. That is the worldview of the left – they have no idea what the consequences are of raising taxes on “the rich”. They don’t think that there are any consequences.

If you would like to see Sally Pipes talk a bit more about Obamacare, you can watch her explain it here:

Eight minutes long.

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Thomas Sowell on health care: thinking beyond stage one

Young Thomas Sowell

Economist Thomas Sowell explains what socialized medicine means for all parties – and what evidence is ignored.

Excerpt:

The same preference for talking points, and the same lack of interest in digging into the facts about realities, prevails today in discussions of whether to have a government-controlled medical system.

Since there are various countries, such as Canada and Britain, that have the kind of government-controlled medical systems that some Americans advocate, you might think that there would be great interest in the quality of medical care in these countries.

The data are readily available as to how many weeks or months people have to wait to see a primary-care physician in such countries, and how many additional weeks or months they have to wait after they are referred to a surgeon or other specialist. There are data on how often their governments allow patients to receive the latest pharmaceutical drugs, as compared with how often Americans use such advanced medications.

But supporters of government medical care show virtually no interest in such realities. Their big talking point is that the life expectancy in the United States is not as long as in those other countries. End of discussion, as far as they are concerned.

They have no interest in the reality that medical care has much less effect on death rates from homicide, obesity, and narcotics addiction than it has on death rates from cancer or other conditions that doctors can do something about. Americans survive various cancers better than people anywhere else. Americans also get to see doctors much sooner for medical treatment in general.

Conservatives are the reality-based community.

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Obama’s health care rationing czar has guaranteed health care for life

Story here from Byron York. (H/T ECM)

Excerpt:

Donald Berwick, recess-appointed by President Obama to head Medicare and Medicaid, is a well-known advocate of health care rationing and admirer of Britain’s National Health Service. Rising health costs and limited resources “require decisions about who will have access to care and the extent of their coverage,” Berwick wrote in 1999. Last year, he said, “The decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open.” Of the NHS, Berwick says simply, “I love it,” adding that it is “one of the great human health care endeavors on earth.”

As it turns out, Berwick himself does not have to deal with the anxieties created by limited access to care and the extent of coverage. In a special benefit conferred on him by the board of directors of the Institute for Health Care Improvement, a nonprofit health care charitable organization he created and which he served as chief executive officer, Berwick and his wife will have health coverage “from retirement until death.”

Rationing for thee, but not for me. It’s the leftist way. And similarly, you can bet that Barack Obama is not going to wait in line for his health care. But you will. Just give him your money and trust him, OK?

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Obama appoints a socialist to run Medicare and Medicaid

Obama has bypassed the Congressional confirmation process for Dr. Donald Berwick, a socialist, and instead given him an immediate recess appointment. What this means is that there will be no debating Dr. Berwick’s socialist views in public.

From the New York Times. (H/T Verum Serum)

Excerpt:

Dan Pfeiffer, the White House communications director, said the “recess appointment” was needed to carry out the new health care law. The law calls for huge changes in the two programs, which together insure nearly one-third of all Americans.

Mr. Pfeiffer said the president would appoint Dr. Berwick on Wednesday. Mr. Obama decided to act because “many Republicans in Congress have made it clear in recent weeks that they were going to stall the nomination as long as they could, solely to score political points,” Mr. Pfeiffer said.

This 2008 NHS paper by Dr. Berwick explains what he thinks about government-run health care in the UK. (H/T Verum Serum)

Excerpt:

The National Health Service [Britain's single payer health care] is one of the truly astounding human endeavors of modern times.  Just look at what you are trying to be: comprehensive, equitable, available to all, free at the point of care, and – more and more – aiming for excellence by world-class standards.  And, because you have chosen to use a nation as the scale and taxation as the funding, the NHS isn’t just technical – it’s political…The NHS is a bridge – a towering bridge – between the rhetoric of justice and the fact of justice.

[...]You plan the supply; you aim a bit low; historically, you prefer slightly too little of a technology or service to much too much; and then you search for care bottlenecks, and try to relieve them.

[...]You could have obscured – obliterated – accountability, or left it to the invisible hand of the market, instead of holding your politicians ultimately accountable for getting the NHS sorted.  You could have let an unaccountable system play out in the darkness of private enterprise instead of accepting that a politically accountable system must act in the harsh and, admittedly, sometimes unfair, daylight of the press, public debate, and political campaigning.  You could have a monstrous insurance industry of claims, rules, and paper-pushing, instead of using your tax base to provide a single route of finance.  You could have protected the wealthy and the well, instead of recognizing that sick people tend to be poorer and that poor people tend to be sicker, and that any health care funding plan that is just, equitable, civilized, and humane must – must – redistribute wealth from the richer among us to the poorer and less fortunate.

[...]please don’t put your faith in market forces. It’s a popular idea: that Adam Smith’s invisible hand would do a better job of designing care than leaders with plans can.  I do not agree.  I find little evidence anywhere that market forces, bluntly used, that is, consumer choice among an array of products with competitors’ fighting it out, leads to the health care system you want and need.

[...]I cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That is for leaders to do.

[...]Unfettered growth and pursuit of institutional self-interest has been the engine of low value for the US health care system.  It has made it unaffordable, and hasn’t helped patients at all.

That’s who is going to administer government-run single-payer health care programs in the United States. He opposes consumer choice. He opposes competition. He wants to have a monopoly on health care, and make your decisions for you. You pay him your money based on what you earn, and he’ll decide which of your neighbors will get health care. You’re smart enough to earn the money, but not smart enough to spend it on your own family. And that’s probably what Obama believes, too, otherwise he would have picked someone else.

Thanks to Verum Serum for finding all of this. They do amazing work breaking these stories. You really need to bookmark Verum Serum and read it every day, if you haven’t already.

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British national health care system prepares to cut 20 billion dollars

Story from the UK Daily Mail.(H/T ECM)

Excerpt:

Millions of patients face losing NHS care as bosses prepare to axe treatments to make £20billion of savings by 2014, a top doctor has warned.

Among procedures being targeted by health trusts are hernias, joint replacements, ear and nose procedures, varicose veins and cataract surgery.

Dr Mark Porter, chairman of the British Medical Association’s consultants committee, warned NHS bosses wanted ‘wholesale reductions in budgets’.

He said primary care trusts – which commission care – are already compiling lists of ‘low value’ operations that would no longer be provided.

[...]Earlier this year the Government’s rationing body said more cuts in medical treatments are planned to save the NHS at least £600million.

Patients could find it harder to get into hospital under plans from the National Institute for health and Clinical Excellence, which advises on drugs and procedures to be funded.

I don’t like this because some people work, and some people don’t work, and then the government decides who gets treated. I think that patients should decide how much they need health care, and make their own decisions about their lifestyles and risk exposure. The NHS systems seems to penalize healthy lifestyles and high earners, while reward the unhealthy and those who choose not to work!

Remember, this is the same NHS that Obama’s health care czar loves! But I don’t like it at all!

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