UPDATE: A new analysis of Obamacare’s role in the conversion of American Medicine to an industry with corporate ethics.
The health system is now like a cocaine junkie hooked on federal payments.
This addiction explains why the insurance companies are lobbying furiously for these funds alongside their new found friends at left-wing interest groups like Center for American Progress. The irony of this alliance is that the left-wing allies the insurers have united with hate insurance companies and want to abolish them. The insurance lobby is selling rope to their hangman.
Hospital groups, the American Medical Association, the AARP and groups like them are on board too. They are joined by the Catholic Bishops and groups like the American Heart Association and the American Lung Association. (If you are donating money to any of these groups you might want to think again.) This multi-billion dollar health industrial complex has only one solution to every Obamacare crack-up: more regulation and more tax dollars.I practiced during what is more and more seen as a golden age of medical care. Certainly the poor had problems with access. Still, most got adequate care, either through Medicaid after 1965, or from public hospitals, many of which were wrecked by Medicaid rules and by the flood of illegal aliens the past 40 years.
Obamacare destroyed, probably on purpose, the healthcare system we had. It had been referred to by Teddy Kennedy, the saint of the Democrats Party as “a cottage industry.” As far as primary care was concerned, he was correct. What we have now is industrial type medicine for primary care and many primary care doctors are quitting.
So why is there waning interest in being a physician? A recent report from the Association of American Medical Colleges projected a shortage of 42,600 to 121,300 physicians by 2030, up from its 2017 projected shortage of 40,800 to 104,900 doctors.
There appear to be two main factors driving this anticipated doctor drought: First, young people are becoming less interested in pursuing medical careers with the rise of STEM jobs, a shift that Craig Fowler, regional VP of The Medicus Firm, a national physician search and consulting agency based in Dallas, has noticed.
“There are definitely fewer people going to [med school] and more going into careers like engineering,” Fowler told NBC News.
There are several reasons, I think. I have talked to younger physicians and have yet to find one that enjoys his or her practice if they are in primary care. That applies to both men and women. Women are now 60% of medical students. This has contributed to the doctor shortage as they tend to work fewer hours than male physicians.
Physicians are the most highly regulated profession on earth. The Electronic Health Record has been made mandatory for those treating Medicare patients and it has contributed a lot to the dissatisfaction of physicians.
THE MOUNTING BUREAUCRACY
This “bottleneck effect” doesn’t usually sour grads on staying the course, Fowler finds, but he does see plenty of doctors in the later stages of their careers hang up their stethoscopes earlier than expected. Some cite electronic health records (EHRs) as part of the reason — especially old school doctors who don’t pride themselves on their computer skills. New research by Stanford Medicine, conducted by The Harris Poll, found that 59 percent think EHRs “need a complete overhaul;” while 40 percent see “more challenges with EHRs than benefits.”
If I remember my arithmetic, that adds up to 99% unhappy with the EHR.
Most primary care physicians I know are on salary, employed by a hospital or a corporate firm. They are require to crank out the office visits and are held to a tight schedule that does not allow much personal relationships with patients. The job satisfaction that was once a big part of a medical career is gone.
Thanks, Mike. I keep reading about how Obamacare has collapsed (or is collapsing) under the weight of it’s own financial flaws and some limited changes to its requirements such as the elimination of the individual mandate, but since repeal and replace was never seriously pursued I had my doubts. Your post cleared that up for me. The structure and special intrests political capture and control of that structure coupled with the pervasive medicare overhead is still firmly intact. This train is headed off the cliff.
I hope a work around emerges.
Death6
It is a shame and a tragedy that the media is full of partisan jackals who know nothing about anything, or else those who warned what Obamacare would do to doctors, to small-business insurance plans, etc., might have been listened to instead of ignored. Instead they just recycled crap talking points from the Grubers and Warrens of the world, just as with foreign policy from likes of Ben Rhodes.
https://wire.ama-assn.org/practice-management/first-time-physician-practice-owners-are-not-majority
“It had been referred to by Teddy Kennedy, the saint of the Democrats Party as “a cottage industry.””
Well, maybe it SHOULD be a cottage industry, at least as far as primary care goes.
It’s funny…’progressives’ are very big on Artisan furniture, and Artisan food, and Artisan this, that, and the other…many of the are hostile to mass production and resent the very existence of factories.
Yet when it comes to the raising of children, they are generally hostile to Artisan childraising, preferring a factory approach to that activity.
Maybe they feel the same about healthcare, although surely the ones who can afford it choose Concierge primary-care services.
I just read this morning:
Since Obamacare was passed in 2010, United Health Group’s stock has risen over 800% while the average family health insurance premium has risen over 200%.
It’s funny”¦’progressives’ are very big on Artisan furniture, and Artisan food, and Artisan this, that, and the other”¦many of the are hostile to mass production and resent the very existence of factories.
Yet when it comes to the raising of children, they are generally hostile to Artisan childraising, preferring a factory approach to that activity.
Conservatives criticize leftists for such inconsistencies. Yet these accurate criticisms leave no mark on their targets because modern leftists tend not to put a high value on consistency. People who value intellectual and ideological consistency and know some history seem most likely to be conservative. People who value impressions, feelings, authenticity seem most likely to be leftists or uncommitteds who accept leftist positions by default. The more you know about the history of stoves and how stoves work, the less likely you are to put your hand on the burner.
The AMA joined the enemy years ago and now exist only as a cash cow for its Board of Trustees.
The first step was when the Feds sued the California Medical Association alleging the Relative Value Scale, created by CMA volunteers back in the 1950s, was “a conspiracy in restraint of trade.”
They made the CMA call back all copies and for several years ariund 1972 we were using Xerox copies as everybody including Medicare used it for fee determinations.
Then the AMA came out with some called Current Procedural Terminology which looked exactly like the RVS that had been banned.
CPT is a registered trademark of the American Medical Association. The AMA holds the copyright for the CPT coding system.[12] However, in Practice Management v. American Medical Association[13] the U.S. Court of Appeals for the Ninth Circuit held that the AMA could not enjoin a competitor on the basis that the AMA had misused its copyright.
Of course, while the RVS was free to all members of CMA, the AMA charges for the CPT.
There are more examples, like the story of the RBRVS in 1986.
RBRVS was created at Harvard University in their national RBRVS study from December 1985 and published in JAMA on September 29, 1988.[6] William Hsiao was the principal investigator who organized a multi-disciplinary team of researchers, which included statisticians, physicians, economists and measurement specialists, to develop the RBRVS.
In 1988 the results were submitted to the Health Care Financing Administration (today CMS) to be used in the American Medicare system. In December of the following year, President George H. W. Bush signed into law the Omnibus Budget Reconciliation Act of 1989, switching Medicare to an RBRVS payment schedule. This took effect on January 1, 1992. Starting in 1991, the AMA has updated RBRVS continually. As of May 2003, over 3500 corrections have been submitted to CMS.
The RBRVS was designed to diminish the value of procedures (surgery) and increase the value of “Cognitive Services” also known as “thinking.”
The internists were ecstatic, one telling me “We will have the surgeons driving Chevrolets while we drive Cadillacs.”
Of course they had been suckered by the Feds who reduced all payment.
The AMA was the only one that made out by selling the RVRBS books.
At one point in 1986, I had my office girl get a copy of the Congressional Record with the law and then, using a spreadsheet to calculate all the fees. For several months, I had the only copy as the CMA had gotten more interested in saving whales than saving doctors. I had doctors’ offices asking for copies.
LOL. Single payer works well. Your medical system is huge scam.
Single payer works well. Your medical system is huge scam.
One of my health policy professors once said “Every system is perfectly designed to get the results it gets.”
If you want rationing and death panels, why not choose the NHS ?
Patients are being denied mental health care, new hips and knees, and drugs to boost their recovery from illnesses including cancer as the NHS increasingly rations treatments to try to overcome its growing cash crisis.
A survey of doctors reveals that three-quarters said they had seen care rationed in their area over the last year – including treatments such as speech therapy, operations to remove varicose veins, Botox to help children with cerebral palsy move better and even potentially life-saving stem cell transplant surgery.
Disabled children were having to use ill-fitting wheelchairs, teenage girls were banned from accessing medication to tackle male-style hair growth and women had been unable to access surgery to have breast enlargements or reductions as a result of growing restrictions across England, the research concluded.
Medical organisations said the findings showed patients were paying the price because an underfunded NHS was having to force them to wait for care or deny it altogether.
The left always wants free stuff. Nothing is more expensive.
That was of course me. A little picture:
http://carnagepro.com/pics/graph-growthofphysicians-administrators.jpg
I agree with your graphic, PenGun.
Obamacare has wrecked US healthcare and it will be difficult to return to a sensible system.
Did you read my post or just jerk your knee ?
This addiction explains why the insurance companies are lobbying furiously for these funds alongside their new found friends at left-wing interest groups like Center for American Progress.
That is what I referred to.
“Did you read my post or just jerk your knee ?”
I’m sorry I was not paying much attention. You just trashed the NHS which has many problems. Some of them stem from the conservative governments meddling with what they had. Not that that was so great but worked for the general population. Now it dose not work very well for anyone.
In Canada we also have many problems. But we keep our population healthier than your strange system. ;)
But we keep our population healthier than your strange system. ;)
Yes your tiny population gets to come to Spokane or Rochester if the Canadian system doesn’t work.
Your supreme court justice said a “healthcare system” is not healthcare.
“In Canada we also have many problems.”
the maple flavoured smugness is no.1
I can tell you the hip replacement wait time is much reduced. My friend Dave had two done with about a month wait on each.
A system that treats everyone is not the same as a ‘for profit’ system and certainly there are problems with both approaches. As a coomie well, socialist leaning person really, I support our system with all its flaws. I certainly am very well served. ;)
You are approaching the limits of your system, and its becoming very expensive as ‘for profit’ guys pile on their crap.
its becoming very expensive as ‘for profit’ guys pile on their crap. Standard Socialist fallacy.
The most expensive things in the world are provided by “non-profits.”
For-profit entities, like hospitals where I practiced for 30 years, only make a profit if cost is less than the price the public is willing to pay.
The leftist thinks that profit is bad and a sign of overcharging.
We are back to Bastiat.
The difference between human and veterinary medical care is striking! Maybe there would be some lessons for us all there, if the Political Class could be forced to pay attention.
Animal care is readily available from multiple providers. It is patient-focused, compassionate, and affordable. It is hard to avoid the conclusion that veterinary care benefits mightily from less government intervention. The impression is that veterinary training is extensive and licensing is stringent — but thereafter vets are less burdened by regulations and their evil partner, lawsuits.
One other issue is that generally we do not make heroic efforts to extend the lives of dying animals, because we do not want to see them suffer. Would that we treated our fellow human beings so kindly!
Post and extensive discussion of hospital billing practices:
https://pjmedia.com/instapundit/306120/
“The leftist thinks that profit is bad and a sign of overcharging”.
The graph says it all. You have turned your medical system into a way of extracting money from people. That has turned into what then traffic will bear, and is a huge scam. This is the reason you pay twice as much for worse results.
“The graph says it all” Actually, “extracting money from people” is not a synonym for “profit’. The graphic doesn’t show anything at all about profit, it shows administrative overhead, ie, money paid to employees of one kind or another and to support those employees.
The graph says it all. You have turned your medical system into a way of extracting money from people. That has turned into what then traffic will bear, and is a huge scam. This is the reason you pay twice as much for worse results.
You misinterpreted the graph. It actually shows how the US medical system has become more mismanaged as it has become more socialistic.
It is impossible to intelligently discuss health care anymore, if it ever was. Conversations inevitably go something like this:
A: Problems with the US health care system shows that the free market can’t deal with health care.
B: Actually, our system isn’t at all a free market, and has gotten less and less so over the last few decades, during which all those problems have gotten worse and worse.
A: Yeah, well, health care shouldn’t be done for profit anyway.
How do you even begin to respond to that? Or this restatement of the same:
“You have turned your medical system into a way of extracting money from people.”
What does that even mean?
“You have turned your food system into a way of extracting money from people.”
“You have turned your housing system into a way of extracting money from people.”
I don’t know how to treat serious illness. Or grow my own food. Or build a sturdy building to live in. But I do know how to write computer programs to do cool things, so I do that for somebody else, and they give me money (i.e., I extract money from them), and then I go to a doctor who knows what to do when I’m sick, and I give him money (i.e., he extracts money from me), and I go to a store to buy food (i.e., they extract money from me), etc., etc.
You have the most expensive system for health care in the first world. You also have one of the worst outcomes, for the health of your people, in the first world.
You must be doing something right. ;) The massive piling on of management for your system, over time should point out that its income that matters, not health results.
“You also have one of the worst outcomes, for the health of your people, in the first world.”
This is not true.
“This is not true.” Elucidate!
What’s the point? Nothing new can be said on this topic. Would your mind change from hearing for the 1000th time about cancer survival rates, etc., or numbers on medical tourism showing how people vote with their feet, or that stats that do show the US lagging are due to effects of violence and car accidents, i.e., things that have nothing to do with the health care system?
What’s the point, indeed, Brian. Or as you wrote even earlier,”What does that (PenG’s “extract money” shibboleth) even mean?”
PenG et al seems very much to aggressively not care about data, not wish elucidation,to have already determined the outcome of any dialogue.
Bastiat, as Mike K observed, covered this…and he did it 200 years ago. PenG & co. do not suffer a lack of sources. They a priori reject those sources. (Have you read Bastiat, Pen? Can you list what he thinks foundational principles governing free exchange? Or even define–or else refute–his idea of free exchange?)
Elucidate, Pen? Elucidate? How about you tell *how* (as opposed to/ contrasted with merely insisting that) your graph does not mean exactly what Mike, David, Jonathan, Brian think it does? How does it instead mean what you claim?
Nor do I ask in jest, Pen. Healthcare is enough of a serious question it deserves careful thought. I’m willing to have my ideas challenged. But I’m gonna apply the same test to that challenge that, iirc, you endorsed Feynman for applying to scientific theory. It’s not like we don’t have plenty of real world data to check a medical system model against. Which set of principles best predict actual outcomes? Use your principles, Pen, predict outcomes, and test that prediction against reality.
Roy
The graph says it all. You have turned your medical system into a way of extracting money from people.
Pennie is demonstrating how he (she?) does not even understand his own links. Arguing is useless when the other party does not even understand his own arguments.
My point is that the US healthcare “system” was altered gradually and then suddenly (the way Hemingway said you go bankrupt) into an industrial system similar to the US auto industry just before it went belly up with Japanese competition.
In the 1950s, doctors were distinctively middle class. As one commenter said, “Doctors drove Buicks.” A family friend, one we spent a month in Michigan with when I was 10, was an excellent orthopedic surgeon. For years he was the team physician for the Chicago White Sox. His wife had been an OR nurse.
His office was in a medical office complex that had a huge waiting room with a telephone switchboard and operator in the middle of the room. Around the waiting room were doctors’ office like his. There was a tiny office and several exam rooms. No big back office where 25 years later, my practice would have 12 or 14 girls doing insurance billing.
Medical insurance was for insurable events, like breaking your arm or leg, which I did three times. Otherwise, you paid cash or tried to if you didn’t have much money. I have the story of medical insurance in my book. It was a mistake to “insure” predictable events like child birth. Even worse was “insuring” well baby care and other primary care.
I was a delegate to the AMA and watched doctors dig their own economic graves with the push to insure routine care.
The graph that Pennie liked to illustrates what happened. The cost of administering all those small claims has taken over healthcare. One error the medical associations made was trying to compete with HMOs that had everybody on salary. Their administrative costs were less because there were no claims.
My wife worked for a while as a Kaiser “Advice Nurse” which is what you got instead of going to the doctor for routine care.
Kaiser members waiting in clinics or called and talked to nurses. Neither involved a claim processing expense.
The only way we will get back to financial sanity in health care is to see a large segment go without insurance for routine care. We are beginning to see that with “concierge practices” and urgent care clinics.
The alternative is rationing as is seen in the NHS. Canada went to a dual system which Pennie pretends does not exist in Canada, plus of course, the numbers that seek care in US border states that have huge medical centers, like Spokane.
OT but more fun with Canada.
”¦’When it comes to negotiating, “Robert Lighthizer is a vicious son of a bitch.””¦
~Gordon Ritchie
The trade agreements are being negotiated. No more NAFTA.
The only way we will get back to financial sanity in health care is to see a large segment go without insurance for routine care. We are beginning to see that with “concierge practices” and urgent care clinics.
The key word is “beginning”. Now if you have insurance you often pay twice, even if you use urgent-care clinics to treat less-serious problems, because insurance policies generally are still priced to cover well-baby, mental-health and similar mandated non-emergency spending that blows up costs in our third-party-payment regime. With interstate insurance competition, reduced coverage mandates and other pending reforms there seems a good chance that major-medical policies will again be available at reasonable prices, allowing most people substantial reductions in their spending. Of course under such a system costs would go down even further as more medical providers began to compete for business directly from patients.
“The trade agreements are being negotiated. No more NAFTA.”
Works for me. We will see how this goes. we don’t have to let your subsidized milk producers destroy our dairy industry for one. You will pay more for cars though.
You have fun with your wonderful health system. I’m happy with mine, it actually takes care of me. ;)
“The trade agreements are being negotiated. No more NAFTA.”
Since we’re now off topic, here’s what they’re saying about it on the Prairies
The re-worked NAFTA reportedly removes the dispute settlement mechanism so cherished and needed by Canada; it changes drug patent laws and redefines how many cars will be manufactured in the U.S. To top it off, Trump’s position is that Canada can only take the deal if we bend on dairy. And, if we don’t accept the agreement Trump will decimate our automotive industry with tariffs as early as next week.
This doesn’t seem much like a negotiated deal. It looks more like the Trudeau trade team signing terms of surrender
I’m happy with mine, it actually takes care of me. ;)
Somebody should. :)
“And, if we don’t accept the agreement Trump will decimate our automotive industry with tariffs as early as next week.”
This is the rub. Our auto industries are so integrated that imposing tariffs on ours will damage you as much as us. We make modular cars these days and the bits are produced where it makes most sense and assembled where it makes the most sense. This will destroy that and cause costs for everyone.
If Trudeau is badly scared by this he can force Trans Mountain and start seriously dealing with China. That will take time but may be the best response. They will be most accommodating, I’m sure. ;)
Our auto industries are so integrated that imposing tariffs on ours will damage you as much as us.
Pennie, no surprise, does not understand that this is all directed at China. You are welcome to give your country to China.
Mexico made a better choice. It is a national security issue to allow our steel industry to be exported to a potential enemy.
We have spent trillions since 1972 to bring China into the world economy. Now it is time to cut them loose and rebuild our own industries that have been so damaged by the globalists.
The left, especially the anti-American left , like Pennie, does not understand that blue collar people will trade a slightly higher price for cars, which can be brought back down by eliminating regulations like CAFE standards, for jobs and higher salaries.
Penny, your Foreign Minister Chrystia Freeland is apparently trying to make some sort of fashion statement.
She’s been wearing the same wrinkled white dress all week. Some kind of women’s rights thing. I’m watching her press conference now. She needs to send it to the cleaners.
A lot of chatter going on about how during her prior journalism career she worked for the Financial Times and Bloomberg. There may have been collusion regarding Trump’s off-the-record remarks during his Bloomberg interview. His unflattering (who is surprised by that?) words were leaked this afternoon in an 1tth hour attempt to derail the NAFTA negotiations.
“His unflattering (who is surprised by that?) words were leaked this afternoon in an 1tth hour attempt to derail the NAFTA negotiations”
Hahaha.
Trump’s said forever that NAFTA stinks. Then he negotiates a new trade deal with Mexico. Then he starts talking to Canada about if they want their own piece of this new trade deal, a deal more to his liking than NAFTA.
In what bizarro world can someone from Canada then derail these talks by leaking Trump being mean? Canada’s got no leverage here at all. If they don’t play ball, if the talks get derailed, NAFTA’s dead, and the notion that that hurts the US and Canada equally is hilariously deranged.
@Grurray. She is probably a vampire. I have a picture, you can almost see the fangs. She come from right where they come from and her dad was a Nazi. ;)
Anyhoo they gonna try again next week.
Freeland must’ve had a rough week. Not only did she pack just one dress, but, unless I was seeing things on the video feed, she also apparently forgot to bring undergarments. I hope she plans better for the resumption of talks next week.
Since the thread is now about NAFTA, here are some details.
“Today the President notified the Congress of his intent to sign a trade agreement with Mexico – and Canada, if it is willing – 90 days from now. The agreement is the most advanced and high-standard trade agreement in the world. Over the next few weeks, Congress and cleared advisors from civil society and the private sector will be able to examine the agreement. They will find it has huge benefits for our workers, farmers, ranchers, and businesses.
“We have also been negotiating with Canada throughout this year-long process. This week those meetings continued at all levels. The talks were constructive, and we made progress. Our officials are continuing to work toward agreement. The USTR team will meet with Minister Freeland and her colleagues Wednesday of next week.” (link)
Under the original 1993 terms and Chapter 22 of the Implementation Act, Lighthizer notifies congress that trade parties have modified the terms; this is the Section 2202 notification of modification. Ninety days after the date of the notification the U.S. and Mexico can sign the new terms of agreement; congressional approval is not required. [Canada can still join the U.S-Mexico agreement but they need to act fast.]
If Canada refuses to join the agreement Lighthizer will follow-up the 2202 modification notification with a Section 2205 notice dissolving the U.S. from the 1993 agreement with Canada; the dissolution is official six months from the date of notification.
During the 6 month period, before official dissolution, the U.S. and Canada can enter into new negotiations for a separate bilateral trade agreement.
If no agreement is made in the six months, prior to the dissolution date, then the terms within an older 1973 trade agreement between the U.S. and Canada take effect. However, it is more likely a new U.S-Canada trade agreement will be made within the six month NAFTA dissolution period as Canada would not want to revert back to a trade agreement almost fifty years old.
Another account of what EHR is doing to doctors.
The report published in the American Journal of Medicine found that the electronic health records (EHR) is destroying the relationship between doctors and patients. The Citizens’ Council for Health Freedom charges the Obamacare requirement that doctors use electronic health records has caused a surge of burnout in the medical profession, explains Joseph Farah’s G2 Bulletin. “The EHR is causing doctors to leave their patients,” said Twila Brase, the president of CCHF and the author of “Big Brother in the Exam Room: The Dangerous Truth About Electronic Health Records.”
Some interesting links. I was once a supporter of electronic medical records and decision systems. I thought they would reduce errors and simplify acute care, especially ICU care. Instead, they were designed to collect data and control doctors so they are just a cog in an industrial system similar to that illustrated in Charlie Chaplin’s “Modern Times.”
There are always trade-offs.
We had “government medicine” and a sort of “single-payer” in the Obama Veterans’ Administration where corruptocrats collected bonuses, pay increases, and kick backs while the patients were left to die. [What can you expect? Old vets would probably have voted GOP and/or Trump.]
I read that the biggest component of costs for Medicaid, HUD housing, food stamps, etc. goes to supporting cheap illegal alien labor for the Chamber of Koch.
A new government system is probably desired by the corruptocrats and the employers of cheap, illegal labor, but it seems that a cheaper functional medical system could be developed if illegals were deported and corruptocrats were excluded. There would not, of course, be as much cash floating through the system but that might make health care for Americans affordable.
At present, there are too many hands in the till to make any system workable.
At present, there are too many hands in the till to make any system workable.
A simple first step would be to do something like France. Post prices in doctors waiting rooms and hospital admission offices.
Some sort of “truth in advertising” showing the real costs and the phony “discounts” that are disrupting the market,
Allow”Balance billing” in Medicare so that providers could charge market rates.
For years, HMO patients paid cash to avoid the long waiting lines in clinics.
Allowing cash payments would put the patient back in charge as a revenue source and not a cost.
One wonders what the NYT wants its readers to think about this story:
https://www.nytimes.com/2018/09/05/us/rural-florida-hospital.html
“So when he proposed starting a 25-bed rural hospital to serve the 50,000 people who live in the farming town of Immokalee and the nearby planned community of Ave Maria, people rallied to the idea. They envisioned a place where mothers could give birth and sick children could get 24-hour help ”” their own novel solution to an exodus of hospital care from rural America.
But then this summer, a larger hospital in Naples derailed those plans by asking the state to deny the proposal, saying that the small, rural hospital would siphon away patients and revenue. The move has upended people’s hopes around Immokalee and delayed any plans to start building the hospital for months. Maybe for good.”
Clearly the government is on the wrong side here, yet will their readers take anything away from that except that the “right” people need to be in the government making regulatory decisions? Doubtful.