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, , , , , , , , , , , , , , , , , , , , , , , , ,

Harry Reid: Obamacare is “absolutely” a step towards single payer health care system

Here’s a Forbes magazine article by health care policy expert Avik Roy.

Excerpt: (links removed)

When I speak to conservatives about health care policy, I’m often asked the question: “Do you think that Obamacare is secretly a step toward single-payer health care?” I always explain that, while progressives may want single-payer, I don’t think that Obamacare is deliberately designed to bring about that outcome. Well, yesterday on PBS’ Nevada Week In Review, Senate Majority Leader Harry Reid (D., Nev.) was asked whether his goal was to move Obamacare to a single-payer system. His answer? “Yes, yes. Absolutely, yes.”

In one sense, this isn’t shocking. Reid and many other Democrats, including President Obama, have often stated that their ideal health-care system is one in which the government abolishes the private insurance market. Video of the PBS discussion isn’t yet online, but here’s how Karoun Demirjian of the Las Vegas Sun described it:

Reid said he thinks the country has to “work our way past” insurance-based health care during a Friday night appearance on Vegas PBS’ program “Nevada Week in Review.”

“What we’ve done with Obamacare is have a step in the right direction, but we’re far from having something that’s going to work forever,” Reid said.

When then asked by panelist Steve Sebelius whether he meant ultimately the country would have to have a health care system that abandoned insurance as the means of accessing it, Reid said: “Yes, yes. Absolutely, yes.”

Reid noted that he and other progressives fought hard for a “public option” in the exchanges as a Trojan horse for single-payer, but Democrats didn’t have 60 votes in the Senate to achieve it:

The idea of introducing a single-payer national health care system to the United States, or even just a public option, sent lawmakers into a tizzy back in 2009, when Reid was negotiating the health care bill.

“We had a real good run at the public option … don’t think we didn’t have a tremendous number of people who wanted a single-payer system,” Reid said on the PBS program, recalling how then-Sen. Joe Lieberman’s opposition to the idea of a public option made them abandon the notion and start from scratch.

Eventually, Reid decided the public option was unworkable.

“We had to get a majority of votes,” Reid said. “In fact, we had to get a little extra in the Senate, we have to get 60.”

Do you like the service you get at the Department of Motor Vehicles or the Post Office? How would you like to get your health care the same way? That’s what the Democrats are trying to do. We could have gone in another direction and legislated consumer-focused health care, providing an experience similar to Amazon.com – but we didn’t. We can’t keep electing communists and then acting surprised when they push us towards communism.

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

Is the economic recovery real or illusory?

The Obama administration has poured about $6 trillion of borrowed money into this economy over the last four years. Has this resulted in a growing economy, or is the economy slowing down?

Take a look at this must-read editorial in the Wall Street Journal.

Excerpt:

The Great Recession is an apt name for America’s current stagnation, but the present phase might also be called the Grand Illusion—because the happy talk and statistics that go with it, especially regarding jobs, give a rosier picture than the facts justify.

The country isn’t really advancing. By comparison with earlier recessions, it is going backward. Despite the most stimulative fiscal policy in American history and a trillion-dollar expansion to the money supply, the economy over the last three years has been declining. After 2.4% annual growth rates in gross domestic product in 2010 and 2011, the economy slowed to 1.5% growth in 2012. Cumulative growth for the past 12 quarters was just 6.3%, the slowest of all 11 recessions since World War II.

[...]February’s headline unemployment rate was portrayed as 7.7%, down from 7.9% in January. The dip was accompanied by huzzahs in the news media claiming the improvement to be “outstanding” and “amazing.” But if you account for the people who are excluded from that number—such as “discouraged workers” no longer looking for a job, involuntary part-time workers and others who are “marginally attached” to the labor force—then the real unemployment rate is somewhere between 14% and 15%.

[...]The number of Americans unemployed for six months or longer went up by 89,000 in February to a total of 4.8 million. The average duration of unemployment rose to 36.9 weeks, up from 35.3 weeks in January. The labor-force participation rate, which measures the percentage of working-age people in the workforce, also dropped to 63.5%, the lowest in 30 years. The average workweek is a low 34.5 hours thanks to employers shortening workers’ hours or asking employees to take unpaid leave.

When we borrow massive amounts of money and spend it today, we should expect to see some sort of return for all of that spending. But it turns out that when government does the spending instead of private citizens and private industry, then much of the money is wasted on nonsense that doesn’t create jobs and grow the economy. The numbers we have today put this point beyond dispute.

The Obama administration has been failing skilled immigrants for the past four years, as well:

When employers can’t expand or develop new lines because of the shortage of certain skills, the employment opportunities for the less skilled are also restricted. To help with this shortage, the administration’s proposals for job-training programs do deserve support. The stress should be on vocational training, postsecondary education and every program that will broaden access to computer science and strengthen science, technology, engineering and math in high schools and at the university level.

But the payoffs from these programs are in the future, and it is vital today to increase the number of annual visas and grants of permanent residency status for foreigners skilled in science and technology. The current situation is preposterous: The brightest and best brains from all over the globe are attracted to American universities, but once they get their degrees America sends them packing. Keeping these foreigners out means they will compete against us in the industries that are growing here and around the world.

This administration prides itself on being “pro-immigration” but they actually favor giving citizenship and voting privileges to millions of people who do not have marketable skills, who cannot speak English, and who disrespect the law by coming here illegally. The administration wants those people to become citizens because those people will vote Democrat. Meanwhile, skilled immigrants with advanced degrees in math, science, engineering and technology can just clear out of the country. They can learn here and work here temporarily, but eventually they have to go home. There are no green cards or naturalizations for skilled immigrants – they have skills, and they may be tempted to do nasty things like vote Republican. Democrats don’t want any of those independent, hard-working immigrants in this country. They are too hard to control and too hard to lie to.

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

New FAA regulations will cause shortage of airline pilots

From the Wall Street Journal.

Excerpt:

U.S. airlines are facing what threatens to be their most serious pilot shortage since the 1960s, with higher experience requirements for new hires about to take hold just as the industry braces for a wave of retirements.

Federal mandates taking effect next summer will require all newly hired pilots to have at least 1,500 hours of prior flight experience—six times the current minimum—raising the cost and time to train new fliers in an era when pay cuts and more-demanding schedules already have made the profession less attractive. Meanwhile, thousands of senior pilots at major airlines soon will start hitting the mandatory retirement age of 65.

[...]Another federal safety rule, to take effect in early 2014, also will squeeze the supply, by giving pilots more daily rest time. This change is expected to force passenger airlines to increase their pilot ranks by at least 5%. Adding to the problem is a small but steady stream of U.S. pilots moving to overseas carriers, many of which already face an acute shortage of aviators and pay handsomely to land well-trained U.S. captains.

[...]Estimates differ on the problem’s magnitude. Airlines for America, a trade group of the largest carriers that collectively employ 50,800 pilots now, cites a study by the University of North Dakota’s aviation department that indicates major airlines will need to hire 60,000 pilots by 2025 to replace departures and cover expansion.

Mr. Darby’s firm calculates that all U.S. airlines, including cargo, charter and regional carriers, together employ nearly 96,000 pilots, and will need to find more than 65,000 over the next eight years.

[...]Dave Barger, chief executive of JetBlue Airways Corp., said in an October speech that the industry is “facing an exodus of talent in the next few years” and could “wake up one day and find we have no one to operate or maintain those planes.”

The same thing is already happening with doctors because of Obamacare. And there is also a broad-based effort to put policies in place that cause private sector businesses to raise their prices, for example, by raising gas prices because of blocks on domestic energy development. Why would a socialist government pass taxes and regulations that cause consumers to become dissatisfied the private sector?

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

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.

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

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