Obamacare’s ambitions to control the entire health care system through a medical mega-bureaucracy endangers the health care system. In addition to the toxic potential for rationing, the attempt to undermine private insurance–both for profit and not for profit–by preventing underwriting and forcing companies to take all comers (toward forcing a single payer system, in my opinion), the financially devastating unfunded Medicaid mandates to the states, the cutting of Medicare, etc., etc., there is more to worry about; the potential that doctors will just throw up their hands and take a hike rather than surrender their professionalism to bureaucrats.
We saw an earlier study indicating that may just happen, which I reported here. And now a survey of 2400 doctors for the Physician’s Foundation, reaches a similar chilling conclusion. From the report:
The research, conducted by Merritt Hawkins, a national physician search and consulting firm, on behalf of the Foundation, comes on the two-year anniversary of the Foundation’s first national physician survey that found growing dissatisfaction among doctors as they struggle with less time for patient care and increased time dealing with non-clinical paperwork, difficulty receiving reimbursement and burdensome government regulations. The new research reinforces those findings and shows that the new health care reform could intensify existing problems for doctors and worsen the shortage of primary care doctors, making it more difficult for patients to access quality care.
Here are some specifics:
• The majority of physicians (60%) said health reform will compel them to close or significantly restrict their practices to certain categories of patients. Of these, 93% said they will be forced to close or significantly restrict their practices to Medicaid patients, while 87% said they would be forced to close or significantly restrict their practices to Medicare patients.
• 40% of physicians said they would drop out of patient care in the next one to three years, either by retiring, seeking a non-clinical job within healthcare, or by seeking a non-healthcare related job.
• The majority of physicians (59%) said health reform will cause them to spend less time with patients.
• While over half of physicians said health reform will cause patient volumes in their practices to increase, 69% said they no longer have the time or resources to see additional patients in their practices while still maintaining quality of care.
• 67% of physicians said their initial reaction to passage of the 2010 Patient Protection and Affordable Care Act was either “somewhat negative” or “very negative” and a great majority (86%) believes the viewpoint of physicians was not adequately represented to policy makers during the run-up to passage of the law.
This is daunting and needs to be looked at very carefully in the new Congress.
Some may argue that it won’t really happen, that it is all bluff and bluster. I don’t think we should be so sanguine. We are already seeing stories of doctors not taking Medicaid and Medicare because of delayed payments, of physicians overworked and underpaid in HMOs, etc. It strikes me that the bigger the government’s thumb on the health care system, the more doctors–particularly those nearing the end of their careers–will say, “It’s just not worth it.”
Here’s a link to the actual report.
December 11th, 2010 | 1:00 pm
[...] This post was mentioned on Twitter by Patty, Vince Humphreys, Desert Cactus, Truth Tweeter, Alberto Fadul and others. Alberto Fadul said: RT @CO2HOG: SHS: Obamacare: Study Finds 40% of Doctors May Quit http://bit.ly/fByuqI #tcot [...]
December 11th, 2010 | 2:20 pm
No fan of Obamacare here, but I suspect much of doctors’ caterwauling about leaving the profession is bogus. My GP says she absolutely cannot expect to leave her practice anytime soon because of the pending changes: she won’t be able to afford to leave.
My only hope with Obamacare, should we be stuck with it, is that the specialists who quickly became multimillionaires by grossly overcharging for a few hours of surgery get some comeuppance and have to get by on less. They have played a key role in making medicine unaffordable and increasing the number of bankruptcies over medical debt on the one hand, while driving up the mortality rate for those who are uninsured and cannot pay for the overpriced surgery on the other hand. (See Wesley’s recent post about the Medicaid patient told to bring $200,000 for his organ transplant because it was no longer covered.) These specialists aren’t going to quit, as they will still be well compensated for their work—just not at the previous obscene levels.
There are still huge profit centers in the current medical field; you simply have to look a little. For example, why would an organ transplant have to cost several hundred thousand dollars? After all, the donor gets nothing! Can you say “profit”, boys and girls? Bet you can… But perhaps reform, whether it’s from Obamacare or whatever replaces it, will change some of this.
December 11th, 2010 | 2:30 pm
As a chiropractor who does not accept insurance I can say that I have reduced overhead, and seen an increase in my patient base. Insurance companies do not add anything to healthcare. In fact they take money out of it. I say dump the insurance system as it is and promote Single Payer as described in the House of Representatives bill HR 676 or California’s measure SB 810. Together we can take a bite out of slime.
Wesley J. Smith Reply:
December 11th, 2010 at 3:44 pm
Single payer will lead to an mess like the NHS.
December 11th, 2010 | 2:51 pm
Why should this “study” be considered?
It’s complete kitsch.
It can’t be considered. It’s not transparent and poorly done. Until we can have answers to the following, the “study” is simply a paperweight:
1) The physicians’ answers need to be assessed by category- specifically with regard to age (health care reform may cause 55yo+ ers to retire simply because they don’t want to change and, well, can retire). Nationwide, I recall a study demonstrating that 33% of US physicians are age 55 or older. Does that stack up with this study? I don’t think so.
2) Speaking of change is different from actually doing it – for example, just because 12% want to move into hospital practice doesn’t mean hospitals will take all comers. tough darts. I’m reminded how 30% of folks say they plan to lose weight come New Year’s resolution – but they never do.
3) These reforms are not addressed in light of affects from potentially increasing the number of physicians in the country. This fallacy only addresses one aspect of the economics – the demand side. We are anticipating a 25% increase in the # of physicians in the next 10 years. How will that affect work loads, pay, and ease of finding new positions?
4) 40% of physicians MAY leave clinical care in a few years. Well, considering that 50% of those surveyed are 51 or older, I’m not surprised that 40% consider leaving. If you are a cardiologist making 400K/yr, why not retire at age 55??
5) because the methods are not transparent, we don’t know if the surveys are representative (are they biased towards increased numbers opposed to reform; FWIW MH is a Republican bastion)
6) here’s my favorite part of this piece of garbage: on page 47 they attempt to break down the survey by age. I’ll leave it to readers to notice the author’s complete inability to perform basic arithmetic and explain their double asterisk.
While I very much appreciate that Smith is attempting to turn to data to support a claim, we must not forget that the quality of the data matters. Let this “study” be an example of why lesser scholars and researchers fail to get peer-reviewed work and often end up needing to work for businesses with a profit agenda, rather than being objective truth seekers.
December 11th, 2010 | 3:10 pm
[...] First Things (blog) [...]
December 11th, 2010 | 4:14 pm
While I am not a supporter of what you term “Obamacare,” I am a proponent of single-payer healthcare as a remedy for some of the problems that the doctors already have or fear they will experience with because of the health insurance legislation.
The Affordable Health Care for America Act (I’ll call it the Act from now on) is unlikely to lessen the paperwork doctors and their staffs must deal with, because the insurance companies are still the gatekeepers for most payment. It will likely increase paperwork, not only because of the increase in the number of patients with insurance but also because the varieties of policies will expand to accommodate the people who didn’t have insurance because of its cost but now must buy coverage. The minimal-style insurance provided already by corporations like McDonalds will likely proliferate, creating more rules for doctors to interpret and adapt to.
Single payer–Medicare for all–streamlines both the care for patients and the payment process for doctors by doing away with the various rules and restrictions the insurance companies impose that eat up precious time resources for doctors, nurses, and their staff.
The need to turn away Medicare and Medicaid patients disappears, because everyone is covered no matter what their age or financial status. There would not be a lower payment to doctors to serve those people currently covered by Medicare and Medicaid.
More time is available to spend with patients, because the bureaucratic hoops doctors must now jump through just to treat a patient whose insurance restricts their coverage–and whose coverage has different rules than the next patient’s, and the patient’s after that–are eliminated.
Please take a look at the legislation proposed for many years by Rep. John Conyers and others: HR 676. You can find it here: http://www.pnhp.org/nhibill/nhi_bill_final.pdf.
You will see that great care has been taken to assure that the “toxic potential for rationing” is not an issue. Read Sec. 102 Benefits and Portability. Also read Sec. 202 Payment of Providers and Health Care Clinicians to see how remuneration for services would function.
As to “the attempt to undermine private insurance,” the Act does no such thing, which is one of its major problems. The Act was constructed with full input from the insurance companies, and by all reports they are very happy with it, indeed. You might want to read former head of Cigna’s corporate communications Wendell Potter’s book Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans, or read his articles and listen to interviews with him, to understand how it is the insurance companies that cause most–if not all–of the problems doctors justifiably complain about.
December 11th, 2010 | 4:23 pm
We’ve seen this story before… the other “study” Smith “reported” that was completely and totally debunked by commenters and the media, including FOX News:
“On the March 17 edition of Fox News’ America Live, host Kelly noted that the survey “was conducted by the Medicus Firm, which is a national physician search firm.” She added: “The New England Journal of Medicine, which was originally responsible for posting, not publishing, but — not conducting the survey, but for posting it on its website — later removed it. It’s not a scientific poll; it’s a survey.”
“Media Matters for America contacted NEJM and received confirmation from spokeswoman Jennifer Zeis that the study had “nothing to do with the New England Journal of Medicine’s original research.” Zeis also made clear that the study “was not published by the New England Journal of Medicine.””
This new “study” Smith pimps was conducted by Merritt Hawkins, another physician search firm. It was suspicious that the methods of the survey were so difficult to find. As it turns out the firm mailed the surveys and received a 2% response rate. This is unacceptable.
It wasn’t a survey of 2,400 docs, it was a survey of 100,000 docs, of which some 98,000 didn’t respond.
How many physicians plan to quit medicine because of the Affordable Care Act? I don’t know, Smith doesn’t know and neither does Merritt Hawkins.
December 11th, 2010 | 4:49 pm
Wes,
Based on what you knew to be true about the previous “study”, why would you double-down on this “study”. Ignorance or dishonesty?
Please address. Your credibility is at stake.
Wesley J. Smith Reply:
December 11th, 2010 at 5:40 pm
Says anonymous Jeffrey. The study’s sponsor was listed. The firm doing the survey was listed. The Foundation’s Web site was linked, as was the actual study itself. It is worth noting that the Foundation was created from funds generated in a class action suit against the private health insurance industry, meaning it is unlikely to be a shill for anyone. Moreover, it echoes what we are now seeing with Medicaid and Medicare docs. As a matter of fact, given the autocratic future of health care in this country if we can’t defang Obamacare, I am surprised it isn’t a higher figure. But the 40% is close to what the previous survey showed. People can judge for themselves what they think. Get your blood pressure medicine ready, Jeffrey–I report, you decide.
December 11th, 2010 | 5:42 pm
Doctors were leaving medicine in droves BEFORE Obamacare.
Wesley J. Smith Reply:
December 11th, 2010 at 5:42 pm
Nick: Righto. And it will only get worse with it.
December 11th, 2010 | 7:03 pm
[...] First Things (blog) [...]
December 11th, 2010 | 10:34 pm
When I hear this kind of talk, it reminds me of when professional athletes say they’re going to retire to pursue “other interests.” Funny how they come back when they find out nobody else in the world will pay them $3 million a year.
What a load of malarkey.
Wesley J. Smith Reply:
December 11th, 2010 at 11:41 pm
P: You had better hope. But many are already refusing new Medicare and Medicaid patients. Just pretending there isn’t a problem doesn’t mean there isn’t a problem.
December 12th, 2010 | 12:49 am
But, putting up utterly mediocre “studies” is hardly reporting. I do think it’s worth taking a look at – just to see what laughable nonsense passes as pseudo-scholarship these days – and use it as a spring board for good ideas and questions. Quality reporting would entail presenting quality studies.
Surveys and studies such as these are complete bunk. They lack any controls and are likely responses mainly from partisans – not very representative at best – certainly not predictive (what people say they will do and what they actually do are very different). Might as well turn to an internet poll by freedom eagles or moonbeam worshipers.
Sure, Obama may claim it’s not a tax and everything will be silky smooth. That’s nonsense, too (actually the former is an outright lie).
December 12th, 2010 | 1:23 am
[...] Care and the DeficitNew York TimesFollowing the Money, Doctors Ration CareNew York TimesObamacare: Study Finds 40% of Doctors May QuitFirst Things [...]
December 12th, 2010 | 12:09 pm
You might find some interesting reading over at my blog as I focus on where the money is made with insurance and it is on the payable side. I mention this as this is the area where insurers are investing to capture even more dollars.
Aetna and United are big time in the news about this recently.
http://ducknetweb.blogspot.com/2010/12/aetna-to-acquire-medcity-health-it.html
United has been doing this for quite a while and what Wendell Potter says about the smoking mirrors with publicity is true. I plaster the world “algorithms” on my blog to help make that point as we are all down to mathematical formulas to determine what our “risk” will be and the insurers “score” us as to what our “loss” will be and they go to any length to get the data. Predictive behavior is another word for it.
Pharmacy benefit managers are also very active in this area as well and you can read about United paying Walgreen pharmacists pay for performance dollars to sign people up in their programs and make additional money.
http://ducknetweb.blogspot.com/2010/10/express-scripts-new-program-to-contact.html
This company is offering a 3million dollar pay out for the algorithms that can predict what percentage of patients will be re-admitted to the hospital.
http://ducknetweb.blogspot.com/2010/12/heritage-provider-network-in-california.html
Transaction fees for processing claims is a huge market to where private equity firms are already making big dollars and want to make more.
http://ducknetweb.blogspot.com/2010/12/transaction-fees-and-services-account.html
For around 15 years a data base, created by Ingenix, a wholly owned subsidiary of United internally and licensed to other insurance companies under paid out of network visits. There are tons of lawsuits out there over this and Cuomo from New York was the one who finally dug in here and got the numbers.
http://ducknetweb.blogspot.com/2009/12/ama-announced-settlement-of-class.html
Again, there are many more lawsuits filed at state levels here but again it was their formulas, or algorithms that generated short pays and put additional money to the bottom line.
Medicare is also a strange circumstance too with their contractors all being insurance companies that run the data systems so with every claim that is submitted there are what is called transaction fees that check data for fraud potential, accuracy, etc. and each one of these processes is a cha ching. Companies that provide this service are traded on the stock exchanges and some are owned by insurance companies.
http://ducknetweb.blogspot.com/2010/11/complicated-algorithms-used-by-medicare.html
It’s all about the data processes that run in the background and until those are changed and/or modified, nothing that any one promises, etc. gets done until those formulas are modified and with insurance companies, we don’t know what they are and they change all the time, thus finding health insurance today becomes a major task.
Again, the money is made with formulas and algorithms and insurers are investing eve heavier in this area as they sell data. All your prescription information is up for sale all the time.
http://ducknetweb.blogspot.com/2010/10/insurers-denied-coverage-based-on-pre.html
Our state of health is constantly analyzed and scored to assess risk and the data and technology behind it makes money, a huge area for savings with healthcare that most do not understand nor see, but it’s there and running 24/7 to make all their decisions with the use of extensive business intelligence data analysis. Data is being combined and analyzed today like it is going out of style.
December 12th, 2010 | 1:27 pm
Wes: “Just pretending there isn’t a problem doesn’t mean there isn’t a problem.”
Likewise, pretending there IS a problem doesn’t mean there is. There’s a difference between smoke and fire, Wes. They’re blowing smoke up our shorts and you think a volcano’s erupting.
They’re holding themselves hostage. Think of Cleavon Little in “Blazing Saddles.” “Back off or I’ll shoot!”
Wesley J. Smith Reply:
December 12th, 2010 at 4:53 pm
You’re just ignoring Slim Pickins and the gang whompin’ on into town, padraig. Besides, that gun was loaded!
December 12th, 2010 | 5:54 pm
[...] Dec. 11, 2010 – ObamaCare, I quit! 40% of physicians said they would drop out of patient care in the next one to three years, either by retiring, seeking a non-clinical job within healthcare, or by seeking a non-healthcare related job. (First Things) More > … [...]
December 12th, 2010 | 8:04 pm
I agree that needing insurance for even everyday health-care is the problem, but why is single-payer always seem to be the only answer presented? Why can no one envision a system where we don’t need insurance or the government to pay for EVERYTHING? Health care was cheaper when we paid for the everyday stuff out of pocket and had insurance for only the catastrophic illnesses or injuries. I know my GP would be cheaper if she didn’t need to pay an entire billing department to make sure she gets her money from the insurance companies.
December 12th, 2010 | 9:09 pm
I think it was Mike Royko, a syndicated columnist, who wrote about incentives for doctors at the outset of the HMO onslaught. His logic still holds, and even more so. His point was that no one would put himself or herself through seven years or more of training, going deeper and deeper into debt, working a hundred hours or more every week, to come out on the other end in a bureaucratized government job that won’t cover expenses, meaning what it costs to run the office plus enough salary to repay that debt. Contra K-man above, this is the proposed equation for physicians. There are shortages of physicians, especially primary care physicians, because no one is giving any thought to how to change this part of the equation if medical costs are to be held down.
December 13th, 2010 | 2:03 am
I strongly agree with the common sense expressed in the last 2 posts. The core flaw in the current health care system in the US is the presence of the third party payer, be that private insurance or government insurance that one has either obligatorily paid into (Medicare) or government insurance that, due to indigence, one has acquired. Everyone knows in every other arena that you save money when you eliminate the middle man. In some situations – say realty – you benefit from the expertise of the middle man. However, there is no benefit to you to have a middle man between you and paying your doctor. If everyone paid out of pocket for their own “routine maintenance” and depended on their health insurance for major matters like surgery and cancer treatment, then the system could run much more simply.
December 13th, 2010 | 8:42 am
Before we get too far afield, let’s reiterate that Wes’ claim that 40% of physicians may quit because of the ACA (there is no such thing as ‘Obamacare’) is most likely false. His claim is fear-mongering. Propaganda. Hysteria.
The supply and distribution of physicians is a serious issue and the subject of much discussion. The “market” concentrates physician specialists in urban markets leaving rural areas underserved by both primary care and specialists.
Many professionals, e.g., scientists, dentists, veterinarians, pharmacists, physicians and lawyers invest years and money in training, why is our greatest concern for physician salaries? Better lobbyists?
December 13th, 2010 | 10:21 am
Karin: “I think it was Mike Royko, a syndicated columnist, who wrote about incentives for doctors at the outset of the HMO onslaught. His logic still holds, and even more so.”
I’m a big Royko fan, Karin, but he’s been proven wrong on this one. I’ve been in an HMO for close to 20 years and I will NEVER willingly go back to the insurance model. My doctors have a steady income and flow of customers.
Also, a relative of mine is a pediatrician who had a private practice for years and dropped it to join a large clinic. He saw more patients and spent more time on medicine and less time doing payrolls and hiring staff.
Royko was a great columnist, but he based this economic model on the image of the old country doctor. We could always use more primary care physicians, but if there is a shortage, HMO’s aren’t the primary cause.
December 13th, 2010 | 10:29 am
Wes: “P: You had better hope. But many are already refusing new Medicare and Medicaid patients.”
Now here’s a basic flaw in your overall argument. You have frequently claimed that nobody in this country is denied medical care due to lack of ability to pay. But you’re ok with doctors refusing patients because they’ll only get paid Medicare rates. How can you reconcile that?
Here’s my best explanation, btw. The doctors that are complaining about ACA and Medicare rates are the ones that also refuse to provide pro bono care. The doctors that do provide pro bono care favor ACA, because it means they may get SOMEthing for their work. That latter group makes up most of the AMA, so that explains why the AMA backs the ACA.
So we can go with the greedheads that backed and bankrolled this bogus survey, or we can go with the majority of doctors that conscientiously back ACA.
Wesley J. Smith Reply:
December 13th, 2010 at 11:21 am
I never said people were denied never “medical care,” which covers everything. I said they are not denied emergency or urgent care.
What next padraig, a law FORCING doctors to take these patients? Why not? If Obamacare is constitutional, why not pass a law forcing doctors to take all patients that walk through their door? Leviathan states can do that.
December 13th, 2010 | 11:39 am
The Big Lie — is that the survey has anything at all to do with “ObamaCare.” In fact, the surveyed doctors are complaining against the present-day state of medical practice, not about aspects of programs that haven’t yet been implemented. Anyone who intentionally conflates this survey with the proposed healthcare reforms is, simply stated, a liar.
December 13th, 2010 | 12:25 pm
Wes: “If Obamacare is constitutional, why not pass a law forcing doctors to take all patients that walk through their door?”
Again, according to you, they are. Unless they’re Medicare patients.
Wesley J. Smith Reply:
December 13th, 2010 at 12:26 pm
No, doctors are free to take or refuse any patient they want. Answer the question: If the Feds can force us to buy insurance, because of its impact on the economy, why can’t it pass a law forcing doctors to take all patients?
December 13th, 2010 | 2:24 pm
Padraig,
My point wasn’t that HMO’s are evil. It was that medicine already doesn’t pay back if you have to pay for the education yourself, and the health care bill will not change this situation for the better, leading more to seek alternate work and fewer to seek medical training.
My husband is a doctor. We are still paying for med school nearly 20 years out and will be doing so for at least another 10 years. We’re not talking small potatoes here – rather, over $40K per year. We have tried private practice, but my husband loves research and so needs an academic setting. He works two jobs to make close to a private practice salary – one in a VA (where the research is) and one on the Canadian border (where the patients need him). Royko’s point had little to do with the country doc. It had to do with the economics of training vs. the economics of earning. We have told the one child (of five) who has expressed an interest in medicine that she should only do so either through the armed forces programs or as a funded MSTP MD/PhD program. I don’t think we’re greedy (although we certainly have seen those who are) – all of his work is relatively unpopular (VA patients, biochem research, rural community practice). But the debt makes it impossible to work just one job. There is no payback for the long years invested in training.
I didn’t mean to get so personal, but we are a good example. At the time my husband graduated, his debt load was relatively rare. Now it’s common.
December 13th, 2010 | 3:05 pm
Karin, I most certainly would not describe you and your husband as greedy. But again, you chose to be outside the HMO or even private clinic economic model, and I applaud your reasons for doing so. But we were talking about the general model. You chose this setup, it wasn’t forced on you by the onslaught of HMO’s. So, no offence, but you’re not a good example. In fact, we could use the differential earnings you passed up to estimate the economic value of your husband doing the work he loves. Probably an economics paper in there somewhere.
The training cost vs. earning evaluation is something everybody has to consider. I have a son going to an excellent and expensive engineering school. I told him when he was looking at it, that he would be far more in debt from that school than he would be from a slightly lesser but far cheaper school that he was also accepted to. He accepted that burden and went to the more expensive school.
December 13th, 2010 | 3:15 pm
Wes: “If the Feds can force us to buy insurance, because of its impact on the economy, why can’t it pass a law forcing doctors to take all patients?”
There are such laws. Most states have laws saying that any licensed medical facility must offer emergency services regardless of ability to pay. Oregon’s was easiest to find:
https://www.oregonlaws.org/ors/441.094
Notice it doesn’t say that the governing body, in this case the state of Oregon, is going to pick up the tab. It’s an unfunded mandate. And THAT is one of the key distortions in our pre-Obama health care system.
Wesley J. Smith Reply:
December 13th, 2010 at 3:20 pm
Those are limited mandates, padraig. They don’t cover every doctor being required to take any patient, or even, to practice at all. The mandate is unconstitutionally overbroad. First nail in the coffin today.
December 13th, 2010 | 5:13 pm
[...] The Physicians Foundation: “The Physicians Foundation today released the results of a national survey of physicians that finds strong negative feelings towards the new health care reform law and fear that patient care will suffer in the months and years ahead. The survey was intended to gauge physicians’ initial reaction to the passage of health reform and to learn the ways in which they plan to respond to it.” Via Wesley J. Smith. [...]
December 14th, 2010 | 3:20 am
Some HMOs are sensibly and at the same time daringly run, others are not. But again, why have the huge layer of bureaucracy of a “Health Maintenance Organization”? Why not just maintain your health via your personal relationship with your physician who you pay directly, without having had the prying eyes of Health Maintenance Organization bureaucrats reviewing your records to “make sure” the doctor didn’t provide more care than he or she was authorized to do? As I asked previously, what benefit to your health is served by this? How is this extra intrusion into your personal medical records justified and how is the associated added expense justified? Answer: no benefit to you is generally added, only negatives result.
The problem thus with “Obamacare” is that it takes us further down the wrong road to Health Care Hell, not away from it.
Todays’s federal ruling in Virginia helps by at least recognizing that the government should not be able to and is in fact NOT constitutionally empowered to compel every citizen – as a condition of merely EXISTING in this country – to purchase a product, even a laudable one…eg health insurance.
December 14th, 2010 | 3:25 am
Correction of typo above: in first line, it should say caringly, not daringly; my keyboard is being temperamental.
December 14th, 2010 | 2:32 pm
Wes: “Those are limited mandates, padraig. They don’t cover every doctor being required to take any patient, or even, to practice at all.”
What are the limits? I didn’t see any in the statute. It said any patient, any provider licensed by the state. Didn’t even exclude illegal aliens.
Wesley J. Smith Reply:
December 14th, 2010 at 3:54 pm
C’mon padraig: If the Feds order ERs to take all comers, and I don’t know that they do, it might be the states, it would be in the context of accepting federal funds. In other words, the Feds induce states and private actors to do all kinds of things with the conditional offer of funds, but it does not require them to take federal funds. Thus, under the Bush conscience clause, heterodox believing health care workers are protected from employment discrimination, IF, and only if, the employer receives federal money. Thus, if a Planned Parenthood employee refused to participate in an abortion, they couldn’t be penalized because PP receives hundreds of millions in federal funds. But a totally private abortion clinic would not be so restricted.
Under your view, the Feds could order a doctor to remain in practice, because if she leaves, it impacts the economics of medicine and the welfare of the country. More to the point, it could order any of us to engage in any commercial activity that the all powerful government believed beneficial to the economy or promotive of the general welfare–whether we wanted to or not.
This is a very big deal APART from Obamacare. It is an unprecedented expansion of centralized federal power that would create a new principle of governance. It needs to be stopped here, or there is no stopping it.
December 15th, 2010 | 11:04 am
Wes: “If the Feds order ERs to take all comers, and I don’t know that they do, it might be the states, it would be in the context of accepting federal funds.”
I quoted you a state statute, that cited state licensed facilities. No feds involved.
You’re clutching at straws, Wes.
Wesley J. Smith Reply:
December 15th, 2010 at 11:15 am
STATE STATUTE! Exactly. You do know the differences between the powers of the states and the Feds, don’t you, padraig?
December 15th, 2010 | 3:00 pm
[...] Obamacare: Study Finds 40% of Doctors May Quit: Research conducted by Merritt Hawkins shows that the new health care reform could intensify existing problems for doctors and worsen the shortage of primary care doctors, making it more difficult for patients to access quality care. Here are some specifics: [...]
December 19th, 2010 | 1:04 am
Chief current problems with the health care delivery system:
1. Third party payer–unnecessary, adds significant expense for no apparent value, intrusive on private medical records and on diagnostic and treatment decisions.
2. Not portable. This is a direct consequence of 1, ie in instances of employer providing one’s health insurance. One switches employer, or simply loses job, and one is left with no insurance, thus in a significantly worse situation than with only losing one’s job. Some folks don’t lose the job but rather, happen to hate their job but, due to good insurance, stay there, essentially indentured to their miserable job due to the great health insurance provided. So lack of portability of health insurance can limit worker mobility; in contrast, if each of us had a personal health insurance account that followed us anywhere in the USA, whomever our employer was could simply deposit $X in that account bi-weekly or however they currently pay our insurance premiums. Then we each get to direct our own healthcare decision-making, would closely monitor how the money was spent and for what tests, treatment, etc. The employers would no longer be encumbered with the hassle and ongoing expense of selecting and administering health plans, doctors would no longer have to hire an entire staff of billers to keep up on the vagaries of the innumerable different health insurers, and doctors would also be freed up from trying to comply with the often idiosyncratic documentation requirements of the assorted third-party payers (private and govt insurers) which would leave them more time to spend with us patients and would leave them less hassled and more happy……and less likely to consider leaving the profession.
3. As touched on above, the extensive mandates as to what must covered if an insurance company wants to be allowed to write insurance policies in your state, also drive up the costs of health care. Additionally, they often drive one or more insurance companies out of the state leaving less competition among the remaining insurance companies which tends to drive up cost and drive down service extent and quality. Typical with monopolies and near- monopolies.
December 22nd, 2010 | 1:32 pm
[...] ObamaCare, I quit! In How It Affects You on 12/2010 at 1:27 PM 40% of physicians said they would drop out of patient care in the next one to three years, either by retiring, seeking a non-clinical job within healthcare, or by seeking a non-healthcare related job. (First Things) More > … [...]
January 3rd, 2011 | 10:56 am
[...] 40% of doctors may quit because of Obamacare. [...]
January 19th, 2011 | 10:50 am
[...] And 78% believe that compensation will be less fair. That fear could drive older or well off doctors into other endeavors or retirement, as other physician surveys have indicated will happen. [...]
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