Free Markets, Free People
As I’ve mentioned many times, the engine of America is small business. Those businesses provide jobs to 85% of Americans. And according to the US Chamber of Commerce, they’re not going to be doing much if any hiring in the near future:
Small business owners’ concerns about the future—particularly on health care and taxes-—are impacting their hiring, according to the U.S. Chamber’s fifth quarterly small business survey released today.
Only one in five small businesses (20%) expect to add employees in 2013, according to the poll of 1,225 small business owners, conducted by Harris Interactive. The majority of small businesses say they are likely to keep the same number of employees over the next year – meaning there is likely to be little change in overall unemployment figures.
Concerns about health care and taxes (both brought to you by Barack Obama) are causing caution among small businesses and that’s because they perceive an “unsettled” business climate. Consequently there’s no incentive for them to change the status quo. In fact, they obviously believe there is some safety in the status quo (see the survey to see how they feel about their businesses locally) .
As we’ve mentioned repeatedly, government policy does have an effect on the economy. It can be an enabler that helps create incentives for businesses to expand and hire or it can be a disabler, doing precisely what it is doing now to unsettle the business climate, create disincentives for expansion or hiring and have small businesses go into a defensive posture.
It doesn’t get more defensive than now.
More from the Chamber survey:
- 78% want government to get out of the way.
- 90% are concerned about the impending fiscal cliff and are worried that Congress will fail to take action to prevent it.
- Nearly 60% say that expiration of the 2001 and 2003 tax rates and other business provisions, coupled with sequestration, will directly impact their business’ growth.
As you might imagine the road map to a better business climate is not hard to follow. There’s just no desire by the class warriors to do that.
Instead of doing the hard work of creating a business climate that will provide small business incentives to expand and hire, they’d rather tax them while demonizing them as the evil rich and talking about “fair shares” to 50% of the country that pay’s no – zero- income tax.
If this doesn’t paint the picture of what is wrong with the policies of this administration, I’m not sure what will. This is Econ 101 stuff. And apparently it is like a foreign language to this administration.
The golden goose is on life support, and the administration is about to pull the plug.
But let’s talk about Bain Capital, shall we?
We already have a physician shortage in this country. And with the passage of ObamaCare, it is likely to get worse.
According to a survey, young physicians (below the age of 40) are pessimistic about the future due to the increased “involvement of government” that ObamaCare promises.
An overview of young physicians in the survey revealed:
- The typical younger physician in this survey is 37 years of age and is an employee of a medical group; with the largest single segment being employees of small groups (6 or fewer physicians): 58% are employees of medical groups, and almost half of those (48%) are with the smaller groups. In contrast, 26% are with mid-sized groups (with 7 to 12 physicians), and 26%
are with larger groups (13-plus physicians).
- These physicians are markedly pessimistic regarding the future of the U.S. healthcare system, with the “new healthcare legislation” ranking as a strong #1 reason for the pessimism. Many voice considerable cynicism with (what several call) “government’ involvement.”
- Financial-related considerations play a key role in the choice of practice/ arrangement. Most cite “income/cash flow” and “employment security” as factors influencing their current arrangement. And among the 27% who changed (or considered changing) their practice/arrangement in the past year, the leading reason given related to “financial issues.”
- The vast majority express satisfaction with their current practice /arrangement (with 35% saying they are “highly satisfied,” and another 45% saying they are “somewhat satisfied”); and most expect to stay with the current practice/ arrangement for 8 years or more. Many (39%) aspire to some form of ownership position in the future (as either sole owner or partner).
There’s a reason for the marked pessimism. They’ve already had to deal with government involvement at the level it now exists and their experience with doing so gives them no confidence that further involvement will lead to any sort of improvement. Quite the contrary they apparently feel it will lead to a degradation in the quality of medicine practiced and an increase in the bureaucratic meddling they’ll have to endure.
Note the satisfaction index with the current system (80% highly or somewhat satisfied). And note also the fact that many aspire to some form of ownership position in the future. I’d put forth a guess that the 39% so aspiring see such a dream as threatened by further government involvement.
As to their pessimism about ObamaCare, the survey says:
These young physicians exhibit considerable pessimism regarding the future of the U.S. healthcare system:
- When it comes to the Affordable Care Act, 49% believe the impact on their practice will be negative, vs. only 23% who believe it will be positive. Among the three practice-types, the Primary Care physicians exhibited somewhat less pessimism vs. the other two segments: They were a bit more likely to be “positive” or “neutral,” a bit less likely to be negative.
- And well over half (57%) are pessimistic about the future of the U.S. healthcare system (with over 30% saying they’re “highly pessimistic”). In contrast, only 4% are “highly optimistic,” and 18% who are “somewhat optimistic”. When asked (open-ended) reasons for their pessimism, responses covered a wide spectrum of negatives – with the “new healthcare legislation” leading the way. Indeed, as one peruses the responses to the question, the cynicism voiced by so many – with most of it directed at “government” – stands out.
Of course it does. And some of their specific comments tell you why:
“Government controlled healthcare will be the downfall. Anyone who has worked in government environment such as VA would know this – ask any vet who receives their care through VA how good the system is!”
“The current administration is only concerned with money and maintaining their power and socialism.”
“Government regulation has too many strings attached. (It) has not been well thought out. (It) will bankrupt the country. (We are) pushing toward socialist medicine.”
“I do not feel optimistic because of all the increased regulatory burdens on physicians. There will be an increased shortage of physicians to provide primary care and decreased access to care.”
“The very reasons why people come to the U.S. to obtain care (research, quality, availability, cutting edge, good physicians, etc) is being taken away one at a time. The changes that are being made are not made with the patient in mind, but with the ‘bottom line’ economically in mind. Not once is the patient mentioned in all these changes.”
“I think the government is destroying healthcare.”
If you read the survey, you’ll find that even the more “optimistic” comments certainly are only relatively optimistic in comparison to the above.
The comment about the reasons people come to the US is the most telling of the group. It pretty well describes what critics of the law have been saying since its passage. You can’t have the best medical care available if the focus is cutting cost. It’s a lie. And pretending that you can do both is the biggest lie of all. That’s precisely the snake oil sales job that has been used to justify the law. But poll after poll has said the American people have rejected the sales job.
It should also be clear that most young physicians have as well. They are not optimistic about the future of US health care.
And if they’re not optimistic, why in the world should patients who will suffer through it hold any optimism either?
This past weekend I pointed to a story in which it was disclosed that the Obama administration was planning to have what were characterized as "mystery shoppers" call doctor’s offices, misrepresent their health insurance status and attempt to find out whether the doctors (all primary care physicians) were taking new patients and if so whether they were taking Medicare or Medicaid patients.
Apparently the blowback was enough to have them shelve the idea (sunshine, what a concept).
The Obama administration will not move forward on a controversial proposal to have “secret shoppers” pose as patients to investigate how difficult it is for Americans to obtain primary care.
“On April 28th, the U.S. Department of Health & Human Services submitted a notice to the Federal Register regarding a proposed study that would examine access to primary care,” an HHS spokesman said in a statement.
“After reviewing feedback received during the public comment period, we have determined that now is not the time to move forward with this research project. Instead, we will pursue other initiatives that build on our efforts to increase access to health care providers nationwide.”
While the administration announced the program two months ago, it did not get widespread notice until a New York Times article that ran on Monday.
And that article spurred many to write about and criticize the plan. Which brings me to this little gem from someone named “Max Read” under the category entitled “Conspiracy Theories” and entitled “Fun new right-wing meme last barely a day”.
Did you hear that Obama wants to spy on all the doctors to ensure that they’re utilizing proper Kenyan medical techniques? No? You must be getting your news from the liberal media establishment, then!
Uh, gee ”Max”, NYT? And by the way, the point was to stop it and it was stopped. So for most of the right-wing, a meme lasting a day is fine especially when it ends with the desired result. Of course, government snooping and misrepresentation ought to be a fun new left-wing meme as well. But apparently, with a Democrat in the White House, all that is fine and dandy.
Finally, as pointed out by our own commenter John in the previous post, their first excuse when confronted with the plan?
The White House defended the survey, saying a similar technique had been used on a smaller scale in President George W. Bush’s administration.
The irony is delicious. The anti-Bush administration who rejected all that Bush did and stood for (even while essentially repeating, renewing or simply using most of it) uses that administration as an excuse to do something. Even a 6 year old would not try that sort of an excuse on anyone. And the more I watch US politics, the more I see the inner 5 year-old come out.
So, even though “Max” the Conspiracy Theorist isn’t particularly impressed (and tries way to hard to be snarky and amusing about it all), its nice to see that pressure and sunlight can quickly stomp an ill-conceived, intrusive and basically dishonest attempt by government to gather information from citizens into the ground.
In fact I’m very happy to see this “fun new right-wing meme” quickly die. It means success.
One of the things many who have studied the problem of health care in the US have known for quite some time is that there is and will be a shortage of primary care doctors in the US. These doctors are the gatekeepers in the system in which health insurance providers require primary care doctors manage the health care of patients and be the ones to authorize referrals to specialists.
The shortage of these doctors isn’t news nor is it something new. Only 30% of practicing doctors are in primary care. 65 million Americans live in areas where a shortage of primary care doctors exists. And ObamaCare’s extension of insurance benefits will add another 30 million to the roles who will have to seek a primary care physician.
So, how does the administration plan to address this known problem? With incentives for such doctors to take Medicare and Medicaid patients whose reimbursement for services is known to be lower than that of private insurance? Announce a plan to incentivize incoming medical school students to become primary care doctors?
Nope. It’s to snoop on existing primary care doctors by enlisting “mystery shoppers” who will falsely identify themselves as potential patients with various types of insurance (Medicare, Medicaid and private) to determine whether the physicians called discriminate among who they’ll accept.
Alarmed by a shortage of primary care doctors, Obama administration officials are recruiting a team of “mystery shoppers” to pose as patients, call doctors’ offices and request appointments to see how difficult it is for people to get care when they need it.
The administration says the survey will address a “critical public policy problem”: the increasing shortage of primary care doctors, including specialists in internal medicine and family practice. It will also try to discover whether doctors are accepting patients with private insurance while turning away those in government health programs that pay lower reimbursement rates.
As you might imagine, doctors who’ve learned about this upcoming attempt are not at all happy with it:
Dr. George J. Petruncio, a family doctor in Turnersville, N.J., said: “This is not a way to build trust in government. Why should I trust someone who does not correctly identify himself?”
Dr. Stephen C. Albrecht, a family doctor in Olympia, Wash., said: “If federal officials are worried about access to care, they could help us. They don’t have to spy on us.”
Dr. Robert L. Hogue, a family physician in Brownwood, Tex., asked: “Is this a good use of tax money? Probably not. Everybody with a brain knows we do not have enough doctors.”
In response the administration says:
In response to the drumbeat of criticism, a federal health official said doctors need not worry because the data would be kept confidential. “Reports will present aggregate data, and individuals will not be identified,” said the official, who requested anonymity to discuss the plan before its final approval by the White House.
Christian J. Stenrud, a Health and Human Services spokesman, said: “Access to primary care is a priority for the administration. This study is an effort to better understand the problem and make sure we are doing everything we can to support primary care physicians, especially in communities where the need is greatest.”
Now, being the skeptic I am and having watched government operate for decades, I tend to see other possibilities in this sort of an effort. Remember, ObamaCare was passed by Democrats, most of whom see health care as a “right”. Thus, they feel they have the right to mandate that a) everyone have insurance and b) that everyone with insurance have access to a physician. They got the “a” done in ObamaCare. Left undone is the mandate that all insured have access to a doctor – without exception. That mandate would be perfectly in-line with their belief that they can demand the skills, assets and time of one to serve the pseudo-right of another.
Why else would this “stealth survey” involving people falsely identifying themselves to doctors to determine whether they discriminate against lower paying insurance programs be planned? The doctor shortage is known. The administration claims that ObamaCare “includes several provisions intended to increase the supply of primary care doctors” and that this survey is intended to “evaluate the effectiveness of those policies. “ Really? Considering that the law has been in effect only a short time and is not fully in effect, one might find it a bit hard to believe that bit of spin.
Instead it seems much more likely that this is a prelude to something else. This is information gathering to prove something – i.e. doctors are discriminating. And we all know that in our new, brave world, “discrimination” is a mortal political sin. Does anyone not believe the outcome of such a survey might be used to attempt to pass an anti-discrimination law or a law which requires primary care physicians to accept anyone with insurance who applies regardless of coverage?
Yeah, me too.