Physician Socialism
I've been engaged in an exchange on Facebook with a couple of MDs who are essentially predicting the death of the medical profession because of healthcare reform. My excellent blog-rival Eric has also suggested as much in a couple comments on a post I wrote earlier on the "doc-fix."
But having given some intense thought to this over the past 24 hours, I've come to a startling realization that just never occurred to me before.
And it has to do with what I'd like to call, in honor of my patriotric conservative friends, "physician socialism." What is this "physician socialism," you ask? It's nothing more than physicians whose livelihoods are so dependent on sucking at the government teat that any threat to that income stream is blasted by anti-reform doctors as un-American and contrary to freedom. Actually, my simple realization is that it's quite the opposite.
Doctors are free to refuse to accept insurance contracts that force them to take "discounted" prices for their valuable services. Doctors are also free to refuse to accept Medicare and Medicaid patients, too, thus rejecting the limits that come with accepting government reimbursements. And then I began thinking that if this healthcare reform bill were so god-awful, why didn't they just really test their services in the free market and institute a cash-for-service practice? In fact, it's what most of us do. But doctors would never accept this because it would mean that their incomes would plummet because they'd be faced with the reality that people just can't afford them at the prices they currently think their services are worth. There is a reason why the AMA supports healthcare reform. It's a means to make more doctors more wealthy through government transfers of wealth right into their bank accounts.
We're not likely to see Medical School admissions dry up in the coming years! We're not likely to see physicians abandon the profession! We're not likely to see physicians go poor! We're likely to see more doctors cashing in!
Think about it: the explosion in the wealth of doctors tracks directly with the expansion of government into the healthcare market via Medicare and Medicaid. Take government out, and doctors who can't compete for the few wealthy individuals who can pay for their expensive care, and we likely have either fewer total doctors, or certainly fewer excessively wealthy doctors. I'd imagine we'd have more doctors like that nice one on the Little House on the Prairie TV series who made housecalls and didn't break regular folks' bank accounts with his exorbitant fees.
But we have a culture where becoming a Doctor is synonomous with obscene wealth.
And yet I gather from my recent communications with some MDs that their incomes depend on anywhere between 50% and 80% of Medicare funds. I gather that there are very few doctors who don't accept a healthy percentage of Medicare patients. What am I left to conclude? That doctors are wealthy primarily because of "socialized" medicine via Medicare and Medicaid. They are the direct beneficiaries of "physician socialism."
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11 comments:
Factor in the amazing costs of malpractice insurance. I used to date a doctor, back in the 80's, and in her first year as a family physician, around 1986, her malpractice insurance bill was around $100k.
True, suspect device. But, then, is government meddling in the "private market" of malpractice lawsuits also not a call for regulating an out of control thing? I'm not opposed to tort reform at all; but conservatives should at least acknowledge that tort reform imposed by the government is no less an intrusion by the government into the market than they claim healthcare reform is. And yet, I would imagine that there are very few "freedom-loving, pro-free market" anti-government healthcare reform conservatives who are also "freedom-loving, pro-free market" anti-government tort reform conservatives.
http://www.bloomberg.com/apps/news?pid=20601087&sid=aHoYSI84VdL0
"The Mayo Clinic, praised by President Barack Obama as a national model for efficient health care, will stop accepting Medicare patients as of tomorrow at one of its primary-care clinics in Arizona, saying the U.S. government pays too little.
More than 3,000 patients eligible for Medicare... will be forced to pay cash if they want to continue seeing their doctors at a Mayo family clinic in Glendale, northwest of Phoenix, said Michael Yardley, a Mayo spokesman.
http://www.chron.com/disp/story.mpl/front/5871311.html
"Only 58 percent of doctors in the state now accept new Medicare patients, according to a recent survey by the Texas Medical Association, down from an estimated 90 percent before 1990. Among primary-care doctors, the percentage is 38 percent."
http://www.kirotv.com/money/22686467/detail.html
Dr. Peterson: "We cannot stay in business by taking more Medicare, and so all the doctors that are dropping or eliminating Medicare are in the same boat."
http://www.kjct8.com/Global/story.asp?S=12073831
"I was with Marillac Clinic. Once I told them that I was now on Medicare, they wouldn't take me," she said.
http://www.reporternews.com/news/2010/mar/03/medicare-situation-worries-doctors-patients/
"The American Medical Association’s Web site said one in four current Medicare patients seeking a primary care physician has trouble, citing MedPAC, Congress’ advisory body on Medicare. For example, a 2010 survey of neurosurgeons found that about 60 percent are reducing the number of Medicare patients in their practices, while 40 percent said they would be forced to decrease the number of new Medicare patients they see, according to the AMA. More than 18 percent of neurosurgeons surveyed said they plan to no longer take new Medicare patients."
http://www.highbeam.com/doc/1G1-88653202.html
"When 68-year-old Elizabeth Reynolds experienced stomach pain recently, she looked around town for a primary-care physician.
She called 12 doctors in Virginia Beach, Va., all of whom turned her away."
http://www.yakima-herald.com/stories/2008/07/09/patients-doctors-cope-with-medicare-meltdown
"The ERs used to be just Medicaid clinics, now they're turning into Medicare clinics," said Rick Linneweh, chief executive of Memorial Hospital.
http://money.cnn.com/2009/10/27/news/economy/healthcare_medicare_doctors/index.htm?postversion=2009110100
"It's so scary that most physicians at Kansas City Internal Medicine, with 65% of its nearly 70,000 active patients age 65 or older, have stopped accepting walk-in Medicare enrollees, said Dr. David Wilt, an internist at the group."
http://community.seattletimes.nwsource.com/archive/?date=20020312&slug=medicare12m
"The 26-doctor Edmonds facility is among clinics and practices around the state closing their doors to new patients insured by Medicare, a federal health-insurance program for retirees and disabled people.
Many clinics also are refusing to take new patients receiving Medicaid, a state-federal insurance plan for low-income residents."
Very interesting, Eric. And all these cases were happening before this healthcare reform bill passed. Man, this reform bill couldn't have come at a better time, don't you think? ;)
It seems patently obvious to me that the reason why doctors are moving away from Medicare is not because the government doesn't pay enough, but rather because the costs of providing healthcare are increasing. I know of doctors who are moving away from taking patients who carry even certain private insurance. Why? Because these private insurers aren't paying enough. And why are these insurers not paying enough? Because they're trying to keep premiums low so they won't lose customers. The fact is that people just can't afford healthcare at its current costs. Period. Let me ask you, Eric, you think these folks on Medicare will be able to sign on to a private health insurance carrier without paying a premium that they cannot afford? What do you propose to do for granny? I don't hear any of these people losing their doctors because they stop accepting Medicare just shrug their shoulders and say, "Oh, well, let me just go buy a private health insurance policy." Granny with her myriad health problems would be laughed out of a private insurer's office. Talk about a "death panel."
Though you would point out these instances as evidence that the healthcare reform bill will just speed this process up, how can you know this since we have never operated under the measures of this new reform bill?
I know that you think this reform bill will only make the situation worse, but "killing the bill" wasn't going to stop all these doctors from shedding Medicare and Medicaid. And your solution to keeping Medicare patients with access to their doctors in the face of rising healthcare costs and stagnating incomes is what, precisely? If you can't afford that life-saving bypass surgery, too bad?
It's all about cost control. And I think this reform bill addresses this problem.
"Though you would point out these instances as evidence that the healthcare reform bill will just speed this process up, how can you know this since we have never operated under the measures of this new reform bill?"
I've said again and again that it doesn't matter to me whether the bill is effective in lowering costs, I would still oppose it for the same reason I oppose a parent pulling a gun on a doctor and telling him he'd better operate on his sick kid, "or else".
Do I think it will work? No. It doesn't solve our supply and demand problems with medical practitioners (I believe it will make this problem worse), it doesn't lower the barriers of entry-to-the-market for effective new drugs and procedures, it doesn't do anything to motivate consumers to become concerned about the true cost of the healthcare they consume, and most importantly it completely ignores the demographic problem of our population structure and its relation to healthcare. Here's the truth, Huck, that nobody in government could ever get elected saying: a whole lot of people are going to get sick and die horribly, simply because there aren't enough people to prevent it from happening, due to the fact that our grandparents had way more kids than our parents did, and our parents had way more kids than we tend to.
Now, could the current healthcare legislation provide a temporarly salve in the problems that are bringing all this upon our society? I doubt it, but perhaps it could. Theoretically, if you have just the right balance, you could force everybody to buy insurance, and then limit the insurance company's ability to use premiums for anything other than paying healthcare costs, and you could lower the cost of insurance (but get off balance just a touch and you could just as easily put all the health insurance companies out of business). If you pay doctors less money and limit the tests they are allowed to run on sick patients, you could lower the cost of healthcare (of course you could also reduce the number of people who want to become doctors, and put some of the healthcare technology companies out of business). But at the end of the day, our future consists of a growing number of sick people trying to extract healthcare from an increasingly limited supply of healers. And that's gonna be expensive no matter what we do, and it isn't going to work out well for everyone.
Or, to put it another way, as bad as things are with healthcare, from a demographics perspective, this is the best it will be in our lifetime. The "baby bust" generation are at the age where they are peaking out on their healthcare expenses, and the boomers are right on their tail. We could knock 5-10% off the cost of healthcare and the boomers would decimate those savings in just a few years based on their sheer numbers.
We currently just don't have the technology or ability to keep the healthcare problem from spiralling out of control. The only hope for making it significantly better for people is through major breakthroughs in medical technology, which this legislation does little or nothing to encourage.
My proposed solutions for healthcare reform would never get very far politically, but I believe they would do the most good:
-Completely overhaul or do away with the FDA. Better yet, keep it, but allow drugmakers to bring their products to the market outside of FDA approval. People who want the safest drugs can buy the ridiculously expensive ones that have been vetted through the FDA process, people who are willing to make their own decisions about risk can pursue cheaper and more experimental drugs (and some will have horrible side effects, and some people will die, but we will make technological progress at a much greater and cheaper rate).
- Deregulate the medical profession, especially general practice. You don't need to go to school for 12 years in order to presribe my kid penicilin for strep throat. In fact, if I can diagnose the exact same symptoms using the exact same process that you do, there is no reason for you to even be involved in the transaction between me and the pharmacist.
- Deregulate medical technology: LASIK surgery, in a relatively free and competitive marketplace, has gotten cheaper, faster, and more available over the last two decades. Getting an MRI is increasingly hard to do, and continues to be incredibly expensive. Whatever regulations prevent those (and similar)services from being treated equally by the marketplace should be done away with.
I've said again and again that it doesn't matter to me whether the bill is effective in lowering costs, I would still oppose it for the same reason I oppose a parent pulling a gun on a doctor and telling him he'd better operate on his sick kid, "or else".
So, it's the "coercive" aspect of the whole thing that you oppose. We've been down this road before, Eric, but we live in a system where the social contract demands "coercion." You can frame your justification of the coercions you support any way you like, but the fact is that all of us are coerced by our authorities whether we like it or not for what our society determines to be the greater good. I am coerced into paying for a war that I think is immoral ONLY because you think such coercion justified and a majority of our legislators happen to agree. I am coerced into paying for coastal restoration projects in Iraq while my own state's coast is eroding. I am coerced into paying for government funded sexual abstinence programs. I am coerced into paying for all sorts of things I disagree with and which you might agree with. I wish your outrage at government coercion would be applied consistently. And I wish you would at least accept that we can't have an effective government, even at the local level, -- hell, we can't have ANY government -- without some measure of coercion.
"we live in a system where the social contract demands "coercion."
Exactly, which is why we enshrine our social contract in our Constitution, so the rules are clearly laid out as to where coercion may and may not be applied. Nowhere in our social contract will you find anything that even hints at giving the federal government the power to coerce citizens to buy a product from the private marketplace. You know and I know that the founders would have rejected such an idea on principle. If that's the road we are headed down, what is your objection to a federal law that says, in order to preserve your right to life, you must buy a gun from a private manufacturer and keep it in your home or else pay a penalty? That's why this is so offensive to me Huck, because (along with the claim of a right to healthcare in general) this is a process that circumvents our social contract.
If you want to make those kinds of sweeping changes to the social contract, and claim these contrived legal rights in order to protect your natural ones, you don't do it with legislative smoke and mirrors, you do it by Constitutional Amendment, which requires more consensus than just 3 votes over even. Anything else, and you are giving people moral license to begin to treat the social contract as corrupt and invalid... and that is a dark path, one that we started on with the passage of Social Security, continued on with Medicare and Medicaid, and one that continues to tear down the social fabric of America every time laws like this get passed.
And as for the things you are forced to pay for that you disagree with, if we could return to a more Constitutional form of government, Huck, I'd be quite proud to relieve you of the duty of paying for those things, with the exception of war and national defense, which are clearly written into our social contract as being the government's obligation to provide.
Completely overhaul or do away with the FDA. Better yet, keep it, but allow drugmakers to bring their products to the market outside of FDA approval. People who want the safest drugs can buy the ridiculously expensive ones that have been vetted through the FDA process, people who are willing to make their own decisions about risk can pursue cheaper and more experimental drugs (and some will have horrible side effects, and some people will die, but we will make technological progress at a much greater and cheaper rate).
You really want to see healthcare costs skyrocket? Watch our litigious society go into full gear under this proposal and watch pharmaceuticals go bankrupt faster than you can say "lawsuit" without the intervening protections of FDA regulation. The FDA, backed by the coercive power of the state, shields big Pharma from the worst aspects of litigation. And it doesn't matter if folks sign hundreds of pages of liability waivers, they're gonna sue, and plenty are gonna win. Now if you think the government should intervene and "regulate" the legal services market via some kind of tort reform, just say so. But then don't pretend you're for "market" solutions. Conservatives hate regulation when it applies to some kinds of market practices, but love it when it applies to others.
Huck, in such a scenarios, the only tort reform I'd support is the one that says if you sign a liability waver, you're bound to it. And that's not really reform so much as it's just enforcing contract law in the face of emotional pleas to do otherwise.
"The FDA, backed by the coercive power of the state, shields big Pharma from the worst aspects of litigation."
Given the hunreds of billions of dollars and decades of time and trouble that big Pharma has to spend to bring new drugs to the marketplace as a result of that arrangement, I'm not at all sure the juice is worth the squeeze.
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