This story typifies, at least to me, the problem we can expect in the health care field if government becomes even more involved than it is now:
Obama administration officials, alarmed at doctor shortages, are looking for ways to increase the supply of physicians to meet the needs of an aging population and millions of uninsured people who would gain coverage under legislation championed by the president.
The officials said they were particularly concerned about shortages of primary care providers who are the main source of health care for most Americans.
One proposal — to increase Medicare payments to general practitioners, at the expense of high-paid specialists — has touched off a lobbying fight.
Family doctors and internists are pressing Congress for an increase in their Medicare payments. But medical specialists are lobbying against any change that would cut their reimbursements. Congress, the specialists say, should find additional money to pay for primary care and should not redistribute dollars among doctors — a difficult argument at a time of huge budget deficits.
The trend for years has been away from general practice and toward specialties. Part of that stems from the fact that specialists are paid more than generalists.
Most of us understand that most of our medical care will take place in our latter years with the obvious exception of certain genetic and chronic diseases which afflict a portion of the younger population. So Medicare, which kicks in at 65 whether you want it or not, is a major payer (and player) to family practice doctors who care for older Americans that make up the bulk of their practice.
With that being the case, we’re seeing fewer and fewer medical students option to become family practitioners, preferring the more lucrative pay specialists earn. The consequent result of low pay, huge patient loads and little recourse for changing that has seen family practice numbers in medical universities drop alarmingly. Why spend all that time and money learning a particular craft when the rewards aren’t as great as you want?
So here we have the market for family practitioners reacting to a distortion in the market created by the government refusing to pay at what the doctors feel is an adequate rate for the treatment of the majority of their patients. The market’s feedback mechanism sends the signal to the potential doctor to look at areas which would be more lucrative than family practice to receive adequate compensation. That area is specialization.
The reason I bring this particular example up is the competing proposals. One say, “hey, if you want more family practitioners, pay them more – that provide the incentive to become a generalist”. On the other hand, there’s a proposal to do that, but to accomplish that increase at the expense of specialists who take medicare.
How do you suppose specialists will react? Well if they do as two of mine have, they’ll simply say, “sorry, we don’t treat Medicare patients”.
And how do you suppose such a decision would effect the number of family practitioners. Well, that would depend on how much they’re willing to increase payments to them.
In the era of massive budget cuts and the promise by government to “decrease” the costs of health care, any increase in my estimation, would by minimal and not enough to change the tide concerning family practice. But taking that increase out of what is paid specialists certainly might be the tipping point for many of them to declare they’ll no longer treat Medicare patients.
Certainly our old friend the Law of Unintended Consequences again at work.
You know, when you’re in DC it seems such a calm and beautiful place, and yet, the cynical machinations of politicians continue unabated.
We now have Nancy Pelosi under fire for essentially sanctioning the “advanced interrogation techiniques” by not speaking up against them or opposing them when she was briefed about their use many years ago:
Nancy Pelosi didn’t cry foul when the Bush administration briefed her on “enhanced interrogation” of terror suspects in 2002, but her team was locked and loaded to counter hypocrisy charges when the “torture” memos were released last week.
Many Republicans obliged, led by former CIA chief Porter Goss, who is accusing Democrats like Pelosi of “amnesia” for demanding investigations in 2009 after failing to raise objections seven years ago when she first learned of the legal basis for the program.
She and her staff can be as “locked and loaded” as they wish, but the fact remains that she’s said nothing about the use of those techniques for 7 years – not a single, solitary word to anyone about opposing them on any grounds.
So the use of these techniques wasn’t something which was going on in a dark corner out of the view or knowledge of Congressional leadership. Democrats have tried to sell that as the “conventional wisdom” – a fascist and authoritarian president making decisions that violate human rights behind closed doors and without the knowledge of the enlightened Dems who would surely have stopped it if they had only known.
But they did know – and said nothing. In the realm of Washington politics that is the same as giving something sanction.
More importantly, Democrats would like for you to believe that these things took place due to an out-of-control executive branch. However, and as usual, this all took place because both Republicans and Democrats in Congress allowed it to take place. When you have the information necessary to stop something you supposedly oppose and do nothing, you become as complicit as anyone.
So as I said in the beginning, Pelosi’s staff as “locked and cocked” as they wish, and they can spin it until they puke, but the fact remains she can’t plead ignorance and she certainly can’t say she did or said anything in opposition, and that that speaks louder than anything her spin machine can gin up in her defense.
Whether or not you agree with the use of the techniques doesn’t change the fact that when it came to “put up or shut up” time where leadership and principle were called to the fore, Nancy Pelosi blew it and any criticism or spin she or her staff now puts forward has the horrific stench of hypocrisy emanating from it.
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Subject(s): The first 100 days, foreign affairs and torture memos – and other stuff.
USA Today says the public sees Obama’s first 100 days as a “strong opening”.
But when you get in the number of the USA TODAY/Gallup Poll, it’s not quite as strong an opening as you might expect:
Now, 56% say he has done an “excellent” or “good” job as president vs. 20% who rate him as “poor” or “terrible.” An additional 23% say he has done “just OK.”
His excellent/good rating on national security is 53%. On the economy, it is 48%.
“He is seen as someone who was handed a large array of challenges and is dealing with them in a sensible way,” adviser David Axelrod says.
Those are lower numbers than I expected. And certainly very interesting numbers on the most pressing interest of the day – the economy. Those numbers also signal to me that this is now considered the “Obama economy” now, whether deserved or not.
As for national security, I’m not sure what rates the number – he’s really not done anything concerning national security except do a little talking about the subject. And, despite claims to the contrary, SEALs taking out three rag-bag pirates who botched a highjacking was not a victory on the national security front.
While I appreciate the fact that we’re hearing a more positive spin from the Obama administration concerning the economy, the so-called “glimmers of hope” aren’t really anything but outliers.
Worse-than-expected news on unemployment and home sales Thursday dampened optimism that a broad economic recovery might be near.
Jobs losses aren’t expected to bottom out until the middle of 2010 and the housing market hasn’t bottomed out yet either:
Meanwhile, the National Association of Realtors said sales of existing homes fell 3 percent in March to a seasonally adjusted annual rate of 4.57 million units, with February revised down to 4.71 million units. Sales had been expected to fall to an annual rate of 4.7 million units, according to Thomson Reuters.
Per the analysis, the best reading of these economic indicators is that perhaps the “free fall” is coming to an end.
“The economic downturn remains intense, but it is no longer intensifying,” said Mark Zandi, chief economist at Moody’s Economy.com. “We are still falling, but we are no longer crashing.”
So, while we may have passed what some are terming the “crisis stage”, the economy is still contracting. I’m coming to believe that we may not see any real and meaningful “glimmers of hope” until mid 2010.
Patterico brings us some good news about Ted Rall:
I don’t normally gloat when someone loses their job, but for this tool, I’m willing to make an exception. Especially given that his “job” consists of comparing U.S. soldiers to suicide bombers; mocking widows of terror victims; profiting from Pat Tillman’s death; assuming the voice of Iraqi soldiers talking about killing American soldiers; making leftist political hay out of the Nick Berg beheading; lying about lefty blogger vitriol; and suing a guy for making him appear to be a “rude, petty, self-absorbed writer/cartoonist” (which is what he is).
I normally don’t celebrate anyone being laid off – but in Rall’s case I’ll make an exception.
Rall will reemerge, unfortunately, but for the time being, he hasn’t the well funded platform from which to spread his crap. I personally find that to be a net positive.
We’re known here at this blog for being adamant about denouncing plans which appease terrorists. It’s a absolute no-win situation for the appeaser. Pakistan is now in the middle of learning that hard lesson:
Pakistan’s strategy of trying to appease Taliban militants is showing signs of backfiring, as extremists move within 60 miles of the capital and threaten to spread their influence throughout the country.
Really? What a surprise. They caved to the Taliban demands and allowed them to impose Sharia law in the Swat valley in return for promises the Taliban would lay down their arms.
And, unsurprisingly, the Taliban have reneged on the promise. That, of course, has Hillary Clinton huffing and puffing at Pakistan:
Secretary of State Hillary Rodham Clinton warned Wednesday that Pakistan’s government is “basically abdicating to the Taliban” by agreeing to let them implement Islamic law in the Swat region last week. Instead of putting down their weapons, as the government had hoped, the insurgents have since moved fighters into the neighboring Buner region, local lawmaker Istiqbal Khan said.
Of course that’s precisely what appeasement buys with zealots. Absolutely nothing except an even weaker position for the appeasers.
Additionally, the Taliban have turned the Swat valley into a theocratic hell while the Pakistani government stands by and tut-tuts:
President Asif Ali Zardari has blamed the Taliban for a wave of assassinations in Swat in recent months, and he condemned a recent video that showed militants flogging a young woman they accused of having an improper relationship.
There is a glimmer of good news however. There seems to be a public backlash building among Pakistanis with even conservative members of the Pakistani parliament distancing themselves from the militants. However in the complicated world of Pakistani politics, that may end up meaning nothing in a real sense as the Taliban, who recognizes no authority and certainly no obligation to live up to any promises, relentlessly pushes to expand its hold on northern Pakistan.
Or so claims David Axelrod.
Apparently Fidel Castro didn’t get the memo:
…At the press conference, as well as in the final meetings of the Summit, Obama looked conceited.
It’s an interesting little diatribe from Casto, and most of it is the usual nonsense, but what it easily demonstrates is Axelrod is as clueless as I asserted a couple of days ago.
Castro saw through most of the Obama rhetoric and unlike a vast number of Americans, figured it out:
When the US President said, in answering to Jake [Tapper], that thousands of years had elapsed since 2004 until the present, he was superficial. Should we wait for so many years before his blockade is lifted? He did not invent it, but he embraced it just as much as the previous ten US presidents did.
That’s the Cuban version of “meet the old boss, same as the new boss …”.
And my favorite:
Leaders just pass through; peoples prevail. There would be no need to wait for thousands of years to pass by; only eight years will be enough so that a new US President — who will no doubt be less intelligent, promising and admired in the world than Barack Obama- riding on a better armored car, or on a more modern helicopter, or on a more sophisticated plane, occupies that inglorious position”
Yup – completely charmed and impressed by our new leader, no?
Castro picks up on and states what he saw – conceit and superficiality. My guess is he wasn’t the only Latin American leader who came away with that impression.
Nick Gillespie at Reason is none too impressed with the new Edward M. Kennedy Serve America Act just signed into law.
At a mere 5.7 billion dollars +200 mil in “stimulus” funds – and yes I’m being facetious (and don’t worry, they’re saving 100 mil among the administration cabinet) – we get legislation that:
reauthorizes and expands national service programs administered by the Corporation for National and Community Service, a federal agency created in 1993. The Corporation engages four million Americans in result-driven service each year, including 75,000 AmeriCorps members, 492,000 Senior Corps volunteers, 1.1 million Learn and Serve America students, and 2.2 million additional community volunteers mobilized and managed through the agency’s programs.
Or an expansion of the Community Organizer’s Full Employment Act if you really want to come clean about it.
Paid “volunteerism”. Is that government’s job?
And as Gillespie points out, the language under which this is organized – and I use the term loosely – is rife with opportunities for urban entrepreneurs to “benefit” mightily from things which will be extremely hard to measure (even though it claims, in the language, to have it covered):
The Serve America Act, which goes into effect on October 1, would increase and enhance opportunities for Americans of all ages to serve by increasing AmeriCorps from 75,000 to 250,000 positions over the next eight years, while increasing opportunities for students and older Americans to serve. It will strengthen America’s civic infrastructure through social innovation, volunteer mobilization, and building nonprofit capacity. The new law is also designed to strengthen the management, cost-effectiveness and accountability of national service programs by increasing flexibility, consolidating funding streams, and introducing more competition.
Ye gods – what could go wrong with that?
And this, as Gillespie points out, in the face of attempts to limit charitable tax breaks for the income class which makes most of those donations and are the engine for much of the charitable giving. Make sense?
Well, it does if your entire focus is to see how dependent on government you can make the population, certainly. This is another example of a liberal wet dream.
But what you should keep in mind is it was begun under Clinton and survived 8 years of a Republican administration.
Tell me – whose fault is that?
Great day yesterday – drove up Skyline Drive which borders the Shenendoah Valley and did the scenery tour. Absolutely beautiful (we’re staying in Charlottesville, VA). Then came back through some of the most beautiful countryside I’ve seen in a while to Montpelier – James Madison’s home.
This was particularly interesting to me because of Madison’s role in writing the Federalist papersand the Constitution and Bill of Rights. The house itself is a work in progress. They only finally restored it to its original dimensions in September of last year (subsequent owners had added on – they took all the additions off of the house and only kept the parts that were there when the Madison’s owned it).
Anyway, probably the most memorable moment for me was standing in Madison’s study, where he penned much of the Constitution and many of the Federalist papers and staring at the ink stains on the wooden floor where his desk had been. It’s little things like that which can bring history alive for a person. That and staring out of the window at the beautiful scenery he looked at as he worked on those incredible documents.
If you get a chance, go see the place. Web site: www.montpelier.org.
Today Monticello, Ash Lawn-Highland (home of James Monroe) and Michie Tavern (of course). Hopefully the Chancellorsville and Fredericksburg battlefields as well.
Ta ta …