Free Markets, Free People
Apparently job burnout effects about 40% of US doctors a recent survey revealed:
Job burnout strikes doctors more often than it does other employed people in the United States, according to a national survey that included more than 7,000 doctors.
More than four in 10 U.S. physicians said they were emotionally exhausted or felt a high degree of cynicism, or "depersonalization," toward their patients, said researchers whose findings appeared in the Archives of Internal Medicine.
"The high rate of burnout has consequences not only for the individual physicians, but also for the patients they are caring for," said Tait Shanafelt of the Mayo Clinic in Rochester, Minnesota, who led the research.
Now imagine the demand that 10 million newly insured that have been given mandated “free stuff” by ObamaCare will add to the load doctors are carrying (don’t forget, we’re supposed to be 90,000 doctors short by 2020).
Yup, again this really isn’t rocket science, but it also obviously hasn’t at all be thought through by our lawmakers, has it?
And the law of unintended consequences will take it’s due course because of that.
That’s reality, something the left routinely attempts to pretend doesn’t exist.
Some examples of the point – ObamaCare will put 30 million more people on insurance rolls Yay, problem of health care solved, right?
No, of course not. There will still be the same number of doctors and hours in a day. As we’ve been saying repeatedly, getting insurance does not mean you’ll be able to see a doctor.
And then there are the new requirements placed on doctors by ObamaCare that further exacerbate the problem.
Take preventive care. ObamaCare says that health insurance must cover the tests and procedures recommended by the U.S. Preventive Services Task Force. What would that involve? In the American Journal of Public Health (2003), scholars at Duke University calculated that arranging for and counseling patients about all those screenings would require 1,773 hours of the average primary-care physician’s time each year, or 7.4 hours per working day.
So, a doctor either commits to 10 or 12 hours of work a day or she sees patients for other reasons for 2/3rds an hour a day.
Or try this:
Meanwhile, the administration never seems to tire of reminding seniors that they are entitled to a free annual checkup. Its new campaign is focused on women. Thanks to health reform, they are being told, they will have access to free breast and pelvic exams and even free contraceptives. Once ObamaCare fully takes effect, all of us will be entitled to a long list of preventive services—with no deductible or copayment.
Of course, none of that is “free”, but much of it will also tie up a doctor’s time. Preventive care costs money – lots of money – and when you have someone else paying for it, even more people will try to take advantage of that.
The left thinks that’s a feature, not a bug.
Here’s the real-world problem, however:
If the screenings turn up a real problem, there will have to be more testing and more counseling. Bottom line: To meet the promise of free preventive care nationwide, every family doctor in America would have to work full-time delivering it, leaving no time for all the other things they need to do.
In effect, it is government mandating treatment that fills up the doctor’s time when much of that treatment may not be necessary. But that call has been taken out of the doctor’s hands with this law. If a patient demands all their “free” stuff, then what?
I often harp on the fact that the left seems sublimely ignorant on how the laws of economics work. Well, what ObamaCare has set up are exactly the same conditions that plague most government run healthcare systems:
When demand exceeds supply in a normal market, the price rises until it reaches a market-clearing level. But in this country, as in other developed nations, Americans do not primarily pay for care with their own money. They pay with time.
Prepare yourself for long waits for what you now consider to be routine problems. If it is routine you will likely have less of a chance of seeing a doctor than you do now. Best hope you can self- medicate or just wait out the problem. If it is a serious problem, you’ll most likely still be in for a wait.
As physicians increasingly have to allocate their time, patients in plans that pay below-market prices will likely wait longest. Those patients will be the elderly and the disabled on Medicare, low-income families on Medicaid, and (if the Massachusetts model is followed) people with subsidized insurance acquired in ObamaCare’s newly created health insurance exchanges.
Econ 101. So what is likely to happen?
When people cannot find a primary-care physician who will see them in a reasonable length of time, all too often they go to hospital emergency rooms.
Uh, wasn’t that a big part of the impetus behind creating ObamaCare? To “solve” that problem? In fact, it is likely to exacerbate it.
Of course the solution to the government made problem will be what? Most likely more government. Those patients who are in those plans that pay below-market reimbursement will complain to whom? Politicians. And vote hungry politicians will try to do what? "Fix” the problem they created. And who will they make the bad guys? Well, certainly not them – greedy doctors or insurance companies most likely.
You can see this coming from a mile off – well if your eyes aren’t full of moon dust and you have even a passing acquaintance with how the real world works.
As P.J. O’Rourke so aptly said, “If you think health care is expensive now, wait until you see what it costs when it’s free.”
Unless this monstrosity of a law is repealed, we’re about to find out.
As we stand by and wait for the ObamaCare law to take effect, enthusiasm within the medical profession seems to be waning (even more) as that time nears:
In late December, a survey of 501 physicians was released by the Deloitte Center for Health Solutions research group, whose parent company serves clients in the health care industry. Nearly half (48%) expected health reform to hurt their incomes this year, while 73% said it would not reduce costs.
Though this isn’t a scientific survey, and other such surveys have and will show physicians’ support for the Affordable Care Act, the early glimpse of the law’s potential impact will likely lead to economic pain for doctors and a diminished system for their patients. Indeed, the Deloitte survey found that 69% of the physicians are "pessimistic about the future of medicine" because of the law.
It may not be scientific, but it certainly seems indicative of attitudes in the medical profession. I mentioned one example of what was shaping this sort of an opinion in an earlier post.
Here’s another little factoid one might find interesting that tells a bit of a story too:
An online survey in September by the Jackson & Coker physician recruitment firm — based on 1,611 doctors who chose to respond — reflected that the majority of doctors don’t believe that the AMA represents their views. The primary reason: the AMA’s support of the legislation. Just 13% of those surveyed backed the Affordable Care Act.
As you recall, the American Medical Association came out in favor of the law.
There’s an unintended consequence from all of this (some would argue it’s intended):
The Association of American Medical Colleges estimates that the USA will be 160,000 physicians short by 2025 (when all patients would be insured under ObamaCare), and this is without even considering those doctors who will limit their practice to insured patients because of decreasing reimbursements or who retire early when faced with increasing costs with little return.
Of course the reason to mention that perhaps the consequences are intended is to point out that this still isn’t the single payer system that those who passed the legislation preferred.
So one has to wonder, how does an ideologue take the lemon of ObamaCare and make it into the socialist lemonade of a government run single-payer system. Well what exists in the form of ObamaCare is certainly a good step one, isn’t it?
It will be so unsatisfactory that one supposes there will be a terrible outcry. With fewer health care workers, care will get worse, not better (to my knowledge the population of the country is still expanding, not contracting). That’s a simple fact that is irrefutable.
Depending on who is in power in DC, government will present itself as the savior to this awful “market failure”. And the usual suspects will dutifully echo and expand on how the market has again let us all down. The result of this will be the final elimination of private insurance as an option for most and the expansion of government control in the guise of the left’s much desired single-payer system
Of course, to make that work, the conscription of all health care workers as government employees.
That scenario isn’t as far fetched as some would like to believe or contend. Obviously, the court fight that’s going on right now will have some say in how or if the scenario develops that way. However, assuming the law is upheld for the sake of argument, and having observed the way the political world works for decades, I think the scenario is quite plausible.
And of course, single payer will be a disaster. Why? Because as Medicare continually proves, bureaucrats think they know more than doctors and certainly more than patients.
There is widespread support, in Congress and among economists, for the broad ideal that Medicare would save money if it paid for better outcomes instead of more procedures. But 20 years of trying to shift the program in that direction have yielded little to no progress, CBO said Wednesday.
CBO analyzed six programs designed to improve care coordination for patients with chronic diseases. They either made no difference or were actually more expensive than the traditional payment system.
That’s because, as noted in the link I cited earlier to the previous post, the bureaucrats refuse to revise their system of payment based on what would best serve the patient. And it isn’t a far stretch to believe the same system would be extant in any single-payer plan. Politicians and economists come and go, but bureaucracies live forever.
So the bomb sits out there ticking away. If it is allowed to explode, it will destroy health care as we know it today and most likely impose an even more debilitated form of Medicare on all. Yes, most seniors say they like Medicare – do they have a choice? Would they like to see an even less capable form of it exist? Just ask them.
In the meantime remember – Freedom equals choice. Whenever choices are limited so is your liberty. When government gets in the business of limiting your choices it is no longer in the business of ensuring your liberty. And limiting your choices in all sorts of areas, to include health care, is exactly the business our government is in today.
Another, in a long line of reasons, to retire the current occupant of the White House in November.
Emergency rooms in “urban and suburban” areas (not rural – the study is limited to urban and suburban) are closing rather rapidly it seems:
Hospital emergency rooms, particularly those serving the urban poor, are closing at an alarming rate even as emergency visits are rising, according to a report published on Tuesday.
Urban and suburban areas have lost a quarter of their hospital emergency departments over the last 20 years, according to the study, in The Journal of the American Medical Association. In 1990, there were 2,446 hospitals with emergency departments in nonrural areas. That number dropped to 1,779 in 2009, even as the total number of emergency room visits nationwide increased by roughly 35 percent.
Emergency departments were most likely to have closed if they served large numbers of the poor, were at commercially operated hospitals, were in hospitals with skimpy profit margins or operated in highly competitive markets, the researchers found.
Sit there for a moment and let that all sink in. Got it? All ready to go? Now, let this sink in:
“This suggests market forces play a larger role in the distribution and availability of care” in the United States, Dr. Hsia said, especially emergency care. “We can’t expect the market to allocate critical resources like these in an equitable way.”
Really? That’s precisely what the market is doing here – Dr. Hsia just doesn’t like it’s method of allocation or the outcome, that’s all. So the hidden premise here is we (the collective) should allocate “critical resources” (emergency rooms and health care providers) differently than the market does (subsidize) and we’ll say a “market failure” made us do it, mkay?
That’s exactly the case Dr. Hsia is trying to build although it isn’t said outright. Market failure requires we (collective) pick up the slack (through government) and pay what is necessary (no matter how much it puts us in debt) to ensure “critical resources” (ERs and docs) are allocated “fairly” (as we think they should). This is also known as a form “central planning” which has always worked so well.
So that would mean unprofitable requiring emergency rooms stay open and we (collective) subsidizing them. BTW, anyone else find it ironic that there’s competition among hospitals keeping prices down to the point that some ERs are unprofitable, yet we’re consistently told that health care costs are spiraling out of control?
Anyway, as you recall the vaunted ObamaCare is supposed to take care of all this, right, because then even the poor will have insurance. And once they have insurance, they’ll never darken an ER again – except when they have a real live emergency. Well here’s a clue junior, the poor already have insurance – its called Medicaid. The problem isn’t lack of insurance, it is a lack of doctors. And it isn’t going to get better soon. Massachusetts has already demonstrated the problem:
When the Massachusetts Legislature made health insurance mandatory five years ago, supporters of the first-in-the-nation law hoped it would keep patients out of hospital emergency rooms.
Patients with insurance, the theory went, would have better access to internists, family practitioners, and pediatricians, lessening their reliance on emergency rooms for routine care.
There is more evidence today that it did not turn out that way.
Three-quarters of Massachusetts emergency room physicians who responded to a survey last month said the number of patients in their ERs climbed in the last year.
They cited ‘’physician shortages’’ along with a growing elderly population as the top two reasons why more patients come to ERs.
The law ‘’didn’t create an infrastructure,’’ said Dr. David John, chief of emergency care at Caritas Carney Hospital in Boston. “Doctors offices are full to capacity.’’
That’s right … MA’s single payer system is swamped. You can waive your magic wand and behold everyone has insurance, but you can’t waive your wand and make health care providers appear. And most doctors know that Medicaid is probably the worst paying insurance out there, not to mention the bureaucratic hassle that goes with it, so they limit their number of Medicaid patient – a prudent small business decision. Because after all, doctors are small businessmen and women. They employ staff, make payrolls, etc. So, just like hospitals that do the same thing, they’re concerned with – what’s that nasty word? Oh yeah, profit.
Nope, the market isn’t the problem here. It is doing precisely what markets should do. The outcome just isn’t the preferred one.
Oh, and under the category “never let reality stand in the way of your reality” or perhaps “facts, who needs facts, I have an agenda”, we find this.
In the middle of last week the buzz was all about McDonalds possibly dropping its health care coverage for its employees because of a requirement called the “medical loss ratio” which mandates that insurance companies spend 80 to 85% of the premium on health care. Because of the McDonalds business model, that’s not possible.
Not to worry we’re told, the administration will work it out with McDonalds. No word on how those businesses in the same boat but that don’t enjoy the political heft of McDonalds will fare.
Earlier in the week we were alerted to the fact that Harvard Pilgrim Health Care will be dropping coverage on about 22,000 senior citizens in the Northeast. Again, thanks to ObamaCare, the promise that if you liked your insurance, “you could keep it” was clobbered by the reality of the law.
Last Friday, two new developments foretold by the critics came to pass.
The first is that the Principal Financial Group has made the decision to stop offering health care insurance as a direct result of the new law:
At the Principal Financial Group, the company’s decision reflected its assessment of its ability to compete in the environment created by the new law. “Now scale really matters,” said Daniel J. Houston, a senior executive at Principal, which is headquartered in Des Moines. “We don’t have a significant concentration in any one market.”
The decision will affect approximately 840,000 Americans. Principal’s insurance product was mostly offered through employers. It’s assessment of the law and what it would cost the company gave it no choice but to quite offering the product.
“If you like your insurance, you can keep it.”
Finally, another problem that critics of the sweeping health care law said was as inevitable as Principal’s decision. A report today says ObamaCare will worsen the doctor shortage:
The U.S. healthcare reform law will worsen a shortage of physicians as millions of newly insured patients seek care, the Association of American Medical Colleges said on Thursday.
The group’s Center for Workforce Studies released new estimates that showed shortages would be 50 percent worse in 2015 than forecast.
"While previous projections showed a baseline shortage of 39,600 doctors in 2015, current estimates bring that number closer to 63,000, with a worsening of shortages through 2025," the group said in a statement.
Legislation passed by Congress is always criticized by some faction or another. Rarely, however, is it ever 100% correct. But in the case of ObamaCare, that may change. Thus far almost every criticism and warning leveled by the opposition to this monstrosity has been shown to be true. Unfortunately we’re just now beginning to see its impact.
Stay tuned for more and more of the critics arguments to be proven right as we wend our way into this almighty mess created by Congress and the President. Today’s news is reason enough to jettison the entire mess as soon as the numbers line up correctly in Congress and the right person is in the White House. Hopefully we’ll only have to wait a couple of years for that all to be in place.