TCS Daily


What the Doctors Think

By Larry Kudlow - September 17, 2009 12:00 AM

Will Americans soon be too sick to work, produce, invest, and generate new prosperity? That's one conclusion you can draw from a new series by Investor's Business Daily, which reveals that doctors are overwhelmingly opposed to a government takeover of health care (including the Baucus plan). Just as important, IBD reports that any government-based health-care overhaul will exacerbate the growing shortage of doctors in this country.

IBD/TIPP found that 71 percent of physicians believe that government cannot cover 47 million more people without significant rationing of health care. And nearly half of the doctors polled say they would retire early if Congress passes the proposed overhaul.

IBD/TIPP surveyed nearly 1,400 physicians for its series. In written responses, doctors have pointed to lower pay, increased government mandates, and less freedom to practice as reasons for the physician shortage. In particular, Medicare and Medicaid, which essentially are running half of our health-care system, continue to pay below-market reimbursement rates that are putting doctors out of business.

Primary-care physicians are the worst off. The American Academy of Family physicians reports that primary-care doctors need a 30 percent pay raise in order to survive. They're not going to get it under Obamacare, or Obamacare Lite. In fact, physician payments will move lower should any of the various House and Senate plans pass.

The Massachusetts Medical Society, operating in a state that has implemented a Washington-like universal-overage plan, reports that primary-care doctors are in short supply for a fourth straight year, that the percentage of primary-care practices closed to new patients is the highest ever recorded, and that seven of 18 specialties — dermatology, neurology, urology, vascular surgery, and obstetrics-gynecology, in addition to family and internal medicine — are all in short supply.

On top of all that, enrollment in medical schools is already declining. By some estimates, the nation will have 159,000 fewer doctors than it needs by 2025.

So what exactly are we supposed to do about this doctor shortage? The easy answer is to create incentives for new doctors. And for that matter nurses. And for that matter hospital space. We should expand and grow the entire free-market health-care system, which up until recently was America's greatest growth industry.

But these government plans will do just the opposite. They will shrink private care and private insurance. They will reduce jobs. And they may well undermine American health and wellness.

Everyone should read the IBD series and consider the health-care debate from the standpoint of the doctors. That's something that hasn't been done yet. But it's darn important.


This article first appeared on Kudlow's Money Politic$.
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154 Comments

Sorry, Larry...
...but this isn't about health care.

This is about control and power. Period.

Control and power by whom?
I agree doctors have been complicit in using government power to protect their cartel in the past. It looks like it has been failing as more doctors are making less money.
It once again proves how cartels fail.

BHO's and the libs plan is certainly a pure power play.

So many industries, computers, Lasik, etc. have proven that consumer control provides the best outcome for all.

What I think
It's about power, disguised as altruistic socialism. This is how the Democrats hope to hold onto congress and the White House. Obama is working hard to increase the number of citizens who do not pay FICA to that of a majority. Once this is achieved, the majority will always vote for the party who keeps them tax-free and in the majority, as well as for the party who will continue to tax the minority to pay for the entitlements of the majority.

I am a licensed psychoanalyst, thus I know how people manipulate each other.

And this is rational?
" Once this is achieved, the majority will always vote for the party who keeps them tax-free and in the majority, as well as for the party who will continue to tax the minority to pay for the entitlements of the majority.'

How long can this last?

You're right
Its about the power and control that health insurance companies have over us, doctors and the government.

Obviously, you like it this way. Obviously, I would like to change the status quo.

The proposals in Congress may not be the best option, but they will change the status quo.

I wonder if their survey asked doctors about their view on a single-payer system. I'd bet money doctors overwhelmingly support single-payer.

Do insurance companies restrict themselves?
Did insurance companies demand the government restrict them from competing across state lines?

"Legalize illegals to get them health care" (aka Amnesty)
"President Obama said this week that his health care plan won't cover illegal immigrants, but argued that's all the more reason to legalize them and ensure they eventually do get coverage.

He also staked out a position that anyone in the country legally should be covered - a major break with the 1996 welfare reform bill, which limited most federal public assistance programs only to citizens and longtime immigrants.

"Even though I do not believe we can extend coverage to those who are here illegally, I also don't simply believe we can simply ignore the fact that our immigration system is broken," Mr. Obama said Wednesday evening in a speech to the Congressional Hispanic Caucus Institute. "That's why I strongly support making sure folks who are here legally have access to affordable, quality health insurance under this plan, just like everybody else. "
http://washingtontimes.com/news/2009/sep/18/obama-ties-immigration-to-health-care-battle/?feat=home_cube_position1

Go for it BHO! Keep accelerating toward the cliff.

The sooner your fellow travelers see what a failure you are, the sooner the adults can regain control.

sure it is rational -- see my other trhead in the other forum on this
It is rational for the Moochers to set things up so they can herd the Mooched Upons in to the cash cow farms.

As for how long it can last? Well, Margaret Thatcher answered that one:

"The problem with socialism is that eventually you run out of other people's money [to spend]."

Yes, I do like it this way
...because despite the limited choices I have, I STILL HAVE SOME.

I can switch insurance companies or lobby my employer to do so. I get to choose between three insurers right now.

And they know it, too. That's why they show up during Open Enrollment and suck up to us.

Now if only the government would allow insurers to offer their products across state lines...I'd have up to 1,300 plans to choose from in theory, and probably close to that in practice.

"I'd bet money doctors overwhelmingly support single-payer."

Riiiight...all those doctors in Canada and the UK moving here to practice sure backs you up on that one, Bob.

Yes
"Did insurance companies demand the government restrict them from competing across state lines?"

That would make sense, its easier to establish a monopoly in a state than in the entire country.

State governments keep the competition from going cross-state. There is no federal law on it.

"Interstate competition made the U.S. one of the world's most efficient, consumer driven markets. "
"Devon Herrick, a senior fellow with the National Center for Policy Analysis who has written extensively on this subject, notes that insurance companies operating nationally would compete nationally. The reason a Kentucky plan written for an individual from New Jersey would save the New Jerseyan money is that New Jersey is highly regulated, with costly mandated benefits and guaranteed access to insurance.

Affordability would improve if consumers could escape states where each policy is loaded with mandates. "If consumers do not want expensive 'Cadillac' health plans that pay for acupuncture, fertility treatments or hairpieces, they could buy from insurers in a state that does not mandate such benefits," Mr. Herrick has written. "

http://online.wsj.com/article/SB10001424052970203550604574360923109310680.html

The you support allowing insurance companies to compete nationally just as the do with auto insurance?

Thats you are part of the problem
We pay twice as much for a system that results in middle tier infant mortality and longevity compared to other countries. I would still rather use American doctors and facilities over anywhere else. THE biggest problem in our system is the health insurance companies' power and control over us, doctors and the government. Its about profits, when it should be about people. You may be happy with the choices, but are you happy with the cost?

You're fortunate to have 3 choices. I have 2 choices, which isn't much of a choice because one is far superior (I even asked at orientation why anyone would take the other option, the ladie's answer was a non-answer), every other job I've had there has been only one provider.

"Now if only the government would allow insurers to offer their products across state lines...I'd have up to 1,300 plans to choose from in theory, and probably close to that in practice."

You're quite naive if you really believe that. For starters, its not "the government" that doesn't allow cross-state competition, its 50 state governments making their own decisions. As such, there may be 1,300 plans that exist right now, but do you really think even close to that many will exist after the dust settles? We'd be lucky to have 20, which is still nice, but doesn't say much for the value of competition. If it follows almost every other example of corporate competition, there will be 4 or 5 giants and a handful of small fries serving local/regional areas. Thats a best-case scenario.


"Riiiight...all those doctors in Canada and the UK moving here to practice sure backs you up on that one, Bob."

Nice, you're such an expert, on everything. So you know why doctors move from Canada to the US do you? This one factor explains it all, huh? There are doctors moving from the US to Canada too, how do you explain that?

Choices
"A small but growing group of doctors Are foregoing health insurance all together. With rising cost of paper and complexities in dealing and complying with insurance companies many doctors are accepting cash only from patients."

http://www.philjoe.com/home/content/rising-medical-complexity-leads-cod%E2%80%99s-cash-only-doctors

"Medical Tourism is the generally accepted phrase used to describe the phenomenon of people traveling outside their home country for medical care, dentistry and surgical procedures. The phrase came into use in the later 1990s in business reporting in the far East, where hospitals targeted the international market for medical services."

http://medicaltourism.com/faq.php?lang=en#1

"Our experienced family nurse practitioners and physician assistants provide the health care you need to get better and stay healthy. We diagnose and treat a variety of common illnesses and minor injuries for patients 18 months and older (24 months and older in Massachusetts). We also offer wellness and preventive services and vaccinations.

Services may vary by state, so be sure to read the "What to know" sections before your visit. To see services available in Massachusetts, click here.

We're in-network with most major insurers, so patients are responsible for either their copay or the price listed on our menu. If you're insured, we recommend you contact your insurance company before your visit to verify coverage, including copays, co-insurance or deductibles. If you are uninsured or prefer to pay out of pocket, we accept cash, checks and credit cards"
Services and Costs

* Minor illness exam $62
* Minor injury exam $62
* Skin condition exam $62
* Wellness & prevention $20-$66
* Vaccinations $30-$112
http://www.minuteclinic.com/services/

And there are many more choices.

Evidentiary
>"I'd bet money doctors overwhelmingly support single-payer."

And I say you'd lose that bet. Unless you can provide some statistical evidence which refutes that provided by the IBD investigations.

And please don't bother with the AMA trope (NPR's favorite tactic) -- only 30% of doctors in the U.S. are AMA members.

"210,000 foreign-educated physicians -- or about a quarter of the nation's doctors -"
http://www.washingtonpost.com/wp-dyn/content/article/2008/02/01/AR2008020103256.html

"The most important factor driving migration is
the wage differential between source and destination countries. In source countries wages may
be deeply insufficient, and public sector health wages may drop sharply during periods of fiscal
austerity. In a WHO study of five African countries, dissatisfaction with remuneration was the
most significant determination of the decision to emigrate.18 While many countries have unfilled
vacancies, the wage differential between the main source and destination countries provides a
significant incentive for migration. Consider the demand presented by the UK alone which
needs to recruit 35,000 new nurses while 50,000 retiring nurses will need replacement by 2008.19
A South African nurse’s salary will double if s/he moves to the UK; a South African physician’s
salary will increase three to five-fold if s/he emigrated to the United States."

"Noteworthy, destination countries are not able to fill medical positions from their own
labor force. Partly this may reflect some of the same relative barriers – suppressed wages in
comparison with other professions, for example. Also significantly, the respect and social
prestige for health professionals (especially nurses and community health workers) may be
lacking. This situation may be exacerbated by practices of physicians and others within the
medical community itself."

page 21 shows 20,000+ medical professionals leaving Canada for the USA, 3,800 from UK

http://www.pubmedcentral.nih.gov/redirect3.cgi?&&auth=0PW4O4AVonaUY7tUZaqIDmCn_bSMTXdgmkkW5s5Aa&reftype=extlink&article-id=2613146&issue-id=159339&journal-id=410&FROM=Article%7CCitationRef&TO=External%7CLink%7CURI&rendering-type=normal&&http://www.fas.harvard.edu/~acgei/Publications/Akire/Migration%2010-25.pdf

No, YOU are the problem
"We pay twice as much for a system that results in middle tier infant mortality and longevity compared to other countries"

Who is 'we'? My health insurance is part of my compensation for my work at my employer. And since I don't have kids, my health care doesn't involve infant mortality, either.

" Its about profits, when it should be about people. You may be happy with the choices, but are you happy with the cost?"

No, but I would rather pay more for the platinum coverage I have than less for crapola.

And all businesses are about profits. Even so-called non-profits.

"We'd be lucky to have 20, which is still nice, but doesn't say much for the value of competition."

As opposed to NO competition after Obama takes it all over? As opposed to the 3-4 choices I have in Califorinia vs 20 nationwide if you were correct (which I don't think you are)?

"There are doctors moving from the US to Canada too, how do you explain that?"

Stupidity. There's a lot of left wing doctors out there, you know.

And, I am not part of any problem...not when the problems is busybodies like you who think you can decide for me what I can or can't get for health insurance -- or even if I want any of it at all.

And we don't abortions do we?
That would really impact the infant mortality rate.

"the economies of fragile countries could be destroyed."
http://www.guardian.co.uk/world/2009/sep/20/swine-flu-costs-un-report

If the UN really cared about those countries with 'fragile' economies, they would be promoting free market capitalism, a system that has been proved to make and economy robust.
But, the UN is a club of thugs that need serfs and slaves to exploit. If they lose there victims, they won't have a country to exploit.
Therefore the most compassionate response for those who want liberty for all is to do nothing to enable the thugs.

Worried abount infant mortality but not abortion?
Liberalism is a mental disorder.

A liberal is more worried about unaviodable deaths than intentional deaths.
One more indication of where "liberals'" priorities lie.

How abortion ties in with the debate.
Besides the immorality of abortion, it is a medical procedure with complications and expense that BHO wants the government to pay for.
States mandate insurance policies pay for fertility treatments. A majority of the women I suspect are beyond prime childbearing years.
So we have a government policy that sanctions the killing of babies before they are born and a government policy to force society to pay for women to make babies.
How insane is that when laws exist to allow for adoption?

A 'liberal' using such statistics is specious....
as they have proven not to really care about the lives of infants.

Killing babies is rational to a libertarian?
What happened to opposing the initiation of violence against all humans?
A baby is not human?

Worried about abortion but not war?
Conservatism is a mental disease.

War is defending life. Abortion is intentionally taking life.

In war, one kills those trying to kill you.
Not innocents like babies.

Still missing the point.
Those using such statistics are specious if they don't really care about infants (those willing to kill them before they are born.)

States DO mandate fertility treatments.
If fertility treatments WERE a choice, I wouldn't care.

"Huge increase in fertility treatment for the over-40s"
"The number of women having IVF treatment in their forties has almost doubled in just seven years as more delay starting a family until their fertility has seriously declined, figures show.

The proportion of IVF patients aged between 40 and 45 has climbed sharply from about 10 per cent between 1991 and 1999 to more than 15 per cent last year, despite low success rates and a lack of NHS provision.

A total of 6,174 women in this age group had fertility treatment using their own eggs in 2006, compared with 3,296 in 1999 and just 596 in 1991, according to data published yesterday by the Human Fertilisation and Embryology Authority (HFEA). Several hundred more tried to conceive using donated eggs, though precise numbers are not available.

Fertility specialists said that the figures show how thousands of women are misjudging their biological clocks by waiting until their late thirties or beyond to try for a baby. When they fail to conceive, they turn to IVF at an age when their best chance of benefiting from it has already slipped away. '

"The average age of all fertility patients has also increased by a full year since 1996, from 33.8 to 34.8, reflecting the wider social trend towards later motherhood. The average age for first births rose from 26.5 in 1994 to 27.5 in 2004, and the average for married women has risen above 30.

The upward curve has alarmed doctors as IVF is rarely successful among the over40s and carries greater health risks both to women and any children they conceive. "
"Angela McNab, the chief executive of the HFEA, said: “It may well be that one of the messages we need to concentrate on is reminding women about their biological clocks, and the increasing difficulties they will have having a baby after 40, and especially after 45.”

Sam Abdalla, a fertility specialist at the Lister Hospital in London said: “This is happening more for social reasons than for medical ones.” "

http://www.timesonline.co.uk/tol/life_and_style/health/article1890359.ece

Last time I checked, fetuses didn't fly the planes on 9/11
...but they do put a crimp into the liberal lifestyle that Bob is defending. That's an even bigger threat and so we march on killing the unborn.
Since Roe v Wade, we've slaughtered over 40 million in the US alone. That's as many people who died in WWII or close to it (depending on if you include the Final Solution genocides).

She doesn't have a right to expect others to pay for it.

A baby is not a woman's body.
A baby is inside a woman's body and is a separate life form.
That is the way it is whether you like it or not.
If a woman doesn't like it, she should sterilize herself as soon as she can.

You can't think for yourself?
Whose life if more valuable, a baby or the mother?
How do you reconcile violence against the baby with the mother's 'right' to her body?
What is the priority?

What is still missing: COST
The only proven way to lower cost and improve quality is competition.
Increase competition across the board in all health care, costs will drop, quality will improve and the cost of insurance will then fall.

Part of being a libertarian is protecting the liberty of others.
Libertarians claim their rights stop the tip of another's nose.
You have a right to do what you want as long as it does not infringe on the rights of the others. Babies are not 'others'?
If an unborn baby as no right to life why would a born baby have the same rights as an adult to life?
As for being Catholic, Ted Kennedy was catholic and supported abortion as do many others who claim to be Catholic.
I said nothing about forcing a woman to be sterilized. I suggest that if she was so afraid of being a woman and having a baby she could see to it she would never be pregnant.

ahhh but Docters do support new health plan with public
http://www.npr.org/templates/story/story.php?storyId=112818960

Still ignoring the issue
I thought libertarians were principled?
What are your principles regarding human life and what are you willing to do to uphold such principles?

These are the ones that won't quit.
40% will quit and 60% will work for the government.

In self defense
One side is the aggressor in war, so your lame statement is only half right. Only the ones being aggressed upon try to kill those trying to kill them. From there, everyone dies.

"War is defending life. Abortion is intentionally taking life."

So no life is intentionally taken in war? Its only defending life? ... Are you sure about that?

Keep rationalizing your hyprocritical views moron.

Neither did Iraqi's
But look at that, we're in Iraq killing people. Including many innocents caught in the crossfire. Rationalize that moron. But, but, but...

Actually, if abortion were illegal there would a lot more poor people in the country, that would be a net positive for liberals. That might be the single most important factor that has allowed any Republican to be elected in the last 30 years.

Imagine if those 40 million pregnancies could have been avoided in the first place. Is that a better solution than to make abortion dangerous and illegal?

Legal or not, abortions will happen. You just want to turn desperate women into criminals and push them into backalleys. Why? Because its easier for you to be an emotional loudmouth than to think about the issue and take a reasoned, complex approach to a very difficult situation.

Talk about a threat. You are a virus that kills its host. Again, for no better reason than you do what is easy, what satisfies your emotional ego.

Exactly
Health insurance companies don't want that. Thats why they fund groups who lie to you and your crazy friends about health care reform so you go to townahlls and act unhinged. Older people are more susceptible to manipulation. Why else would a person on Medicare rail about government involvement in health care? They love their Medicare! They're scared they'll lose it and at the same time they believe the propaganda from the right - hence, townhall whackos.

"The you support allowing insurance companies to compete nationally just as the do with auto insurance?"

Yes I do. But lets not be mistaken either, health insurance is not much like auto insurance. See below.



Iowa researcher points out that health insurance really isn't insurance
Lost in the debate over a public option health insurance plan, says a University of Iowa insurance expert, is the fact that health insurance differs in many ways from other types of insurance.

“Insurance manages risks that are unknown, such as a house fire or an automobile accident, by transferring them to an insurance company in exchange for a premium,” says Ty Leverty, assistant professor of finance in the Tippie College of Business and Tristar risk management fellow. “The insurer, in turn, manages the risk by pooling together a large number of risks. Health insurance, however, frequently covers things that are known.”

Leverty says economists suggest health insurance differs from other types of insurance in three key ways:

“In the health care debate, it seems many people who are opposed to change say they like their current insurance because they don’t pay much for it, or so they think. If they knew how much that insurance costs them, they might not like it so much.”
—Ty Leverty


Health insurance covers routine expenses. Health insurance covers the cost of predictable things, like an annual checkup, mammograms or cholesterol tests. “That’s like asking auto insurers to cover the cost of a tune-up,” Leverty says.

Health insurance covers small, random expenses. People expect health insurance to pay to visit a doctor for minor things, like confirming that we have the flu or wart removal. “We don’t expect our auto insurance to pay for the costs of replacing a burned out headlight,” Leverty says.

Many Americans get their health insurance through their employers, not on their own. As a result, a lot of people don’t really know how much they’re paying for it, and thus, don’t know how much their health care really costs.

“In the health care debate, it seems many people who are opposed to change say they like their current insurance because they don’t pay much for it, or so they think,” says Leverty. “If they knew how much that insurance costs them, they might not like it so much. Moreover, many people like their insurance because they have never really tested it for uncertain events. One only knows how good their insurance is when they really need it.”

Leverty says a part of health insurance really is insurance—the part of the policy, for instance, that pays to cover injuries that truly are unforeseen, like covering the cost of stitches after you cut yourself while slicing a bagel or the costs associated with catastrophic illnesses.

But most expenses that Americans expect their low-deductible health insurance to cover—annual checkups, prescription drugs, wart removal—are not unforeseen expenses. In that case, he says health insurance is often more like a cash-flow management policy.

by Tom Snee

a fetus isn't an infant
You're still missing the point because you're unable to see beyond your own need for validation of your views. You can't even talk to people you agree with unless they kowtow to your whim.

The only infant I care about is my own. Isn't that how it should be? Why are you so hard on socialists when you promote a socialist viewpoint regarding abortion? You want the government to intervene!

No competion will make prices lower and quality higher?
Where has this ever been demonstrated?

Of course killing is intentional in war.
That's how one stops the enemy from fighting, kill them all or kill enough so they will stop fighting.
Worked with Germany and Japan.

Socialists promote abortion.
And want the state to pay for it.

One legitimate function of government is to protect life, especially innocent life like babies.

Socialists promote death and rape.
Planned Parenthood aborts babies from underage girls who have been raped and fail to report the rape.
Socialists promote human euthanasia.
Socialists promote homosexual marriage (zero offspring, species death) and forced Catholic Charities out of the adoption business.

For claiming to be for 'the people', socialists are in practice, anti-people.

Very interesting
Marjon, you appear to be trying to force Joanie into a "principled" position of forcing a certain behavior from other people. That doesn't sound libertarian to me. It doesn't fit your view of anarchanistic form of society either. In fact, its quite socialist of you. Since when do you concern yourself so much with controlling other people??


A fetus is not a baby. I just read about a little experiment. A teacher took embryos of 6 different aniamls and had the class vote which one is the human embryo. The human ended up in third, behind a turtle and something else (can't remember what).

No they don't
How do socialists promote abortion? Seems quite the opposite, you are promoting socialism by demanding the government control womens' decisions.


Sure, socialists want government to pay for abortions, they want government to pay for everything.
Whew! I guess that means I'm not a socialist because I don't want government to pay for abortions. Its a voluntary procedure, it shouldn't be covered.

"One legitimate function of government is to protect life, especially innocent life like babies."

It does protect babies. A fetus is not a baby.

Your statement signals you support the DDT ban because the ban protects life. Is that your position?

No they don't
The grim reaper promotes death and rapists promote rape. Thats it.


"Planned Parenthood aborts babies from underage girls who have been raped and fail to report the rape.
Socialists promote human euthanasia.
Socialists promote homosexual marriage (zero offspring, species death) and forced Catholic Charities out of the adoption business."

Wow. Are you naive, ignorant or just dumb? Or all 3?

Regardless, prove any one of those. I dare you.

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