Where is health care going ?

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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.

A long analysis of physician incomes shows that 22% of females report part time work vs 12% of males.

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.

China, Taiwan, and the Third World

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China has been making many investments in third-world countries, often in exchange for resource concessions.  There is growing concern that some of these projects leave the host country with too much debt–indeed, last December, Sri Lanka sold control of its port of Hambantota to a Chinese state-owned company after falling behind in repaying $1.5 billion in loans from Beijing.  Further such situations seem likely.  (See interesting article about Chinese investment in Malaysia here.)

China has also been accused of using aid and investment funds to influence other countries’ policies toward Taiwan, an accusation that they unsurprisingly deny…and Taiwan is now down to only one diplomatic ally in Africa, the kingdom of  eSwatini  (prevously known as Swaziland.)  El Salvador, too, has recently dropped diplomatic ties with Taiwan.

See also my recent post about Chinese influence efforts targeted at other nations, including the limiting of US film content and the firing of an American employee of Marriott for liking a tweet which offended the regime.

 

 

Smashing Pumpkins in 2018 and 1991

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The Smashing Pumpkins came to Portland on Saturday, August 25th at the Moda Center (the arena where the Portland Trail Blazers play). It was a good show and the sound was excellent (we recently saw a show at the Veterans Arena adjacent to the Moda Center and the sound was so terrible we walked out half-way through the show).

They played the hits – most of the show was based on their first few albums – Gish, Siamese Dream, and Mellon Collie and the Infinite Sadness, and a bit of their next two.  There wasn’t a lot of their most recent work – the local paper described the show as “Give the Gen X’ers What They Want”.

The whole band was there except for original bassist D’Arcy.  Like (nearly) everyone else, I had my story of when I ran into the Smashing Pumpkins back in Chicago – James Iha and D’Arcy were behind me in line at Best Buy purchasing CD’s a long time ago.

While I love the Smashing Pumpkins unconditionally, I can see how Billy Corgan’s “woe is me” routine would be grating.  He had a bad childhood and it was highlighted from the very first song “Disarm” where he had pictures of himself as a child with annotations and they weren’t happy, for sure.

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Suspicion and the Corruption of the Liberal Mind.

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I had a cartoon on my office door in the 80’s. An elderly man, sitting in a beach chair next to an elderly woman, looks out over the ocean with a frown.  “I’ve come full circle.  I think things are what they seem.”

I begin to see why it has pleased me so much

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I point you to yet another Quillette article, Suspicion and the Corruption of the Liberal Mind, by Stephen Harrod Buhner. I have grown fond of the site, and need to discipline myself to go over there more often. Buhner says he is a “liberal to the core,” but has grown weary of the current approach of other liberals. He in turn refers us on to Rita Felski, a professor of English at UVA whose most recent book, The Limits of Critique, discusses the liberal approach to culture and art in terms of mood. (Her definition of this occurs early on in Buhner’s essay.) She too is a liberal raising red flags.

I wanted to excerpt a quote from either Buhner or Felski to give you sense of their argument, but it took a while to settle on just one. This is Buhner:

Those who have absorbed the mindset now extend suspicious reading to everyone and everything anyone does: words, body language, dress, hair, music, art, even food. They actively reject the face value of communication, whether literary or social; hold nothing as innocent of power motivations, whether directly or through unconscious complicity in those power motivations.

To regard the majority of Western peoples as possessing malign motives; to base a life upon such a point of view; to approach all books, plays, art, and human interactions with this kind of suspicion is not, however, a sign of clear-eyed perception but rather, as one of my psychology professors once put it, a diseased mind. Like its more extreme cousin, paranoia, it becomes self-perpetuating: the more suspicious one is, the more vigilant one becomes; the more vigilant one is, the more evidence one finds in even the most innocent of behaviors; and the more evidence one finds, the more suspicious one becomes.

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Seth Barrett Tillman: My Post on CONLAWPROF: On Elected Judges and Elected Prosecutors

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It strikes me that the complaint against judicial elections (as voiced on this listserv) is rooted in the absence of life tenure — not elections per se. You could have elections filling judicial vacancies — but with the candidates’ receiving life tenure. And you could have appointments by political authorities to fixed and limited judicial terms — with the possibility of reappointment. The threat to the rule of law (such as it is), lies with the prospective candidate for reelection/reappointment to judicial office biasing his/her decision for self-interested reasons. But that conflict of interest will appear whenever you have terms of limited duration with the possibility of reelection/reappointment. It is not elections per se that create the conflict.

This is an excellent point.

Read Seth’s post in full.