Sunday, July 10, 2011
Bleeding Coverage
I consider myself an American who wants the country to succeed no matter which party is running it. And I want President Obama's health-care bill to succeed as well. I just find myself a little bit concerned by several aspects of it...............................................................................................I've already mentioned the huge number of exemptions and the fact that the penalty simply isn't stiff enough to secure compliance. Another potential problem is the fear that a lot of these 30 million new folks being covered (and possibly many more currently on private coverage - this, in that their employers may ultimately end up dropping them and agreeing to pay the penalty instead) may eventually end up on Medicaid, easily the crappiest insurance coverage in the country (I mean, yes, it's better than nothing but, still, 50% of doctors today don't even accept it)...............................................................................................I'm also disturbed by some of the surveys that I've seen. According to Business Investors Daily and the Medicus Group, upwards of 45% of physicians say that they would consider leaving the profession and/or retiring early. Granted, they may simply be blowing smoke here but, still, in a country that already has a major doctor shortage (not specialists - we clearly have plenty of them - G.P.s, I'm saying), there simply may not be enough of them to go around. Sadly.
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33 comments:
45% of physicians leave the profession and/or retiring early = good riddance.
It's a good start, right WD? Because nothing makes a healthcare system run better than to have hardly any doctors to provide services. Why not propose a bounty on doctors to further eliminate this profession?
No, dmarks. I think this "bounty on doctors" idea of yours is terrible.
The solution is to do something about the AMA, which is limiting the number of medical schools it will accredit and the number of students admitted to those schools.
We need to accredit more medical schools and admit more students. I propose we bypass the AMA and create a government accreditation process.
More doctors would create more competition and wages (and the cost of health care) would fall... This is something, if one were to go by his previous rhetoric, one might guess dmarks would support... paying doctors real value wages... yet his comment doesn't mention anything of the sort.
As for these doctors who might leave -- I said "good riddance" because I think weeding out the doctors who are only in it for the money instead of caring for patients is a GOOD thing.
How do we induce more doctors to become GPs? That's where the real shortage is.......Admitting more students? I'm assuming that they're qualified, right?
If 45% of doctors actually did leave the profession (and I doubt very seriously if that many actually would), that would be an absolutely catastrophic thing for the country. And for you to talk so flippantly about it totally underscores your lack of seriousness.............And you're also assuming that these doctors are only concerned about the money. Maybe a lot of them are also concerned about what this piece of legislation (all 2,700 pages of it) will do to patient care. Most of the people that I know are driven by more than one motivational force.
Will: for you to talk so flippantly about it totally underscores your lack of seriousness...
I'm an extremist... what do you expect? Anyway, I stand by what I said, but only because I don't buy that "45% leaving" figure AT ALL. People who are only in it for the money are most likely bad doctors and I think it would be a good thing to get rid of them.
Maybe then Congress would do something about the AMA's monopoly. It's quite apparent they aren't going to do anything about it otherwise.
Like I said, I'm for INCREASING the number of doctors... which I think is the ONLY serious solution.
I don't know what your solution is, but from your post it sounds to me like you think we should repeal The Affordable Care Act to appease some a-hole Republican doctors who are making empty threats.
I do agree that the AMA needs to be revamped. As for doctors needing to be paid for their value. They already are paid well and in fact overpaid compared to other civilized countries... thanks to the AMA.
The problem is that we need more doctors who care about healing rather than income. I pay $75 for about ten minutes of actual time with my doctor. That works out to about $350.00 an hour... which is the real reason that people cannot afford health care.
The whole idea of providing government health care is foolish anyway. The care we have through the government now is so over burdened that it can't afford to cover anyone else.
If 45% of all doctors (and I agree with you that a lot of them may be blowing smoke) left the profession (especially if a large chunk of them were primary care providers), the system would totally crumble (especially with these 30 million new patients). And, so, yes, your "good riddance" comment is amongst your most chilling............."Doctors who are only motivated by money" - yet another of your oversimplified and hackneyed bromides. As I tried to explain to you, human beings are rarely, if ever, motivated by one thing. And I'm not exactly sure that there's a psychometric device which we could utilize anyway.............And how precisely do you plan to "get rid" of all these greedy (you're assuming that they're all Republicans - YET ANOTHER flaming stereotype) practitioners? You simply ask them what they think of the President's healthcare plan, and, if they flat-out give it a thumbs down, you take away their license? That better not be the case because my doctor doesn't like the bill and he's a damn good doctor.............As for the AMA, didn't that organization actually endorse Mr. Obama's plan?
I hate to say it, Rabbit, but $75 for an office visit is probably amongst the lower figures. Scary, huh?............As for the AMA, I've heard that less than 30% of the doctor's in this country are actually a part of it. If that's the case then, yeah, they definitely have way too much power.
By "get rid of" I was referring to the doctors leaving the profession of their own volition. If they want to leave that is THEIR DECISION. I'm not for revoking anyone's license. I was talking only about doctors CHOOSING to quit.
I didn't assume they are all Republicans... I said "some".
I don't know what your solution is, since you refuse to say. If a doctor doesn't like the legislation he should be exempt? We should chuck the legislation entirely to appease these doctors?
The AMA endorsed the legislation because they were bought off. All US based medical schools are accredited by the AMA. The AMA limits the number of schools and number of students they accredit. That is where their power lies, not with how many doctors join after graduating.
If more people were allowed to study medicine and more doctors graduated the result might be lower wages for doctors... would you object for that reason?
I love stats. 50% of all stats are 50/50 at best and the rest are made up on the spot.
If we're going to throw people in prison for not buying health care insurance (as some Republicans have suggested) then why not throw doctors in jail who refuse to accept a patient's insurance (be it a government or non-government policy)?
I actually enjoyed statistics in college, CDM. You're right, though, statistics (the cherry-picked ones, especially) can basically prove anything.
I wouldn't mind it if more people took up medicine, wd. As long as we're not lowering the standards for acceptance and licensing it would actually be a good thing.............You want a constructive piece of criticism for Obamacare? a) No more exemptions and maybe even get rid of the ones that they've already given out (we need EVERYBODY to be a part of this). And b) make the penalty for noncompliance bigger (no, not prison - I can't say that I agree with those Republicans). We have to eliminate (as best as we can) the possibility of people waiting until they get sick to purchase insurance. Do those 2 things and I think that the bill gets better.
Do those 2 things and then do a third thing... add a public option.
I'm not for lowering the standards for acceptance and licensing of doctors... that would be completely unnecessary. All we need to do is break the AMA's medical school accreditation monopoly.
Doctors might end up making less though... is that why you're so suspicious?
It never ceases to amaze me when I hear the healthcare bill being described as some kind of "government takeover" of medicine or conversion to socialism.
This law is at best a tepid step in the right direction. The doctors are dragging their feet and making a fuss in the hopes that the few gains we've made will be reversed.
Of course medicine will collapse. Look at the anarchy and bedlam in Canada, the United Kingdom, and literally every other industrialized Western country.
wd, I remember when the far left made a big deal about Rand Paul not being certified with the AMA's board of opthamology (he was certified with another board). It's like, what, the AMA serves a purpose only occasionally?............Seriously, though, if the AMA doesn't accredidate schools, who then? Rand Paul?
Brightenedbooy, the healthcare bill is basically a knockoff of, not one but several Republican plans. One could rightly criticize it for many things. It being a radical bill wouldn't be one of them.
We can also make it easier for people to be doctors by banning frivolous lawsuits.
Remember Jon Edwards, who got rich on such courtroom lies as when he claimed that OB-GYNs can create genetic birth defects, and he destroyed careers and profited.
As for a public option (a misleading and vague named for government-controlled healthcare) it is a very bad idea for many reasons.
"Obamacare" is a big step in the wrong direction, Bright. Starting with how the plan forces families to give $$$ to private insurance plans that aren't in their interest. And just because something is all the rage in Europe doesn't means it is a good idea at all.
As for Canada, I think of my Canadian friend who is happy she lives near the border so she can cross into the US to get the healthcare denied in Canada.
Her daughter is one of those people Rahm Emanual calls "f**king retards", and Bill Maher says isn't even human at all. These people (and yes they are people, WD) get screwed by the Canadian system.
Will: I remember when the far left made a big deal about Rand Paul not being certified with the AMA's board of ophthalmology (he was certified with another board)...Seriously, though, if the AMA doesn't accredit schools, who then? Rand Paul?
No, the issue wasn't that he is certified with "another" board; the issue was that he is certified by his OWN board -- a board HE founded.
Fuck Randal Paul. He's a nutjob who doesn't belong in the Senate. He says he's going to filibuster any increase in the debt ceiling UNLESS he gets a balanced budget constitutional amendment. Not only would the amendment NEVER pass, there is absolutely no way it could pass before the debt ceiling needs to be raised (these things typically take years). Not to mention the fact that the idea is totally stupid.
So, yea, Randal Paul is the guy who should accredit medical schools (you said your question was serious, but suggesting Randal Paul? NOT serious).
I think Congress should pass a bill setting up an accreditation board to certify additional schools. The bill could also provide funding for those schools and scholarships for the students. I think free tuition in return for a few years of public service would be a good idea.
Additional ideas for solving the problem can be found here: Wikipedia/Doctor Shortage/Proposed Solutions.
All the proposed solutions sound intriguing except the idea to "improve physician wages, such as through privatization of health care systems thereby enhancing market attractiveness for people to become doctors".
I think increasing costs is a terrible idea. I suspect, however, that this is the solution you (and probably dmarks too) think would work best.
WD said: "Fuck Randal Paul. He's a nutjob who doesn't belong in the Senate."
I agree. How can anyone speak authoritatively about a government program when they don't know what it is called?
I have heard him on many intereviews talking about something called "So Security"
"Not to mention the fact that the idea is totally stupid."
But I do agree that a balanced budget amendment is needed ASAP. Balanced budgets are not stupid, but constant yearly $1.5 trillion deficits ARE. Anyone who would vote against it is saying "I'm not fiscally responsible whatsoever"
dmarks: We can also make it easier for people to be doctors by banning frivolous lawsuits. Remember Jon Edwards, who got rich...
"Frivolous" is how Republicans refer to JUSTICE for people injured by bad doctors. Eliminating the right to sue by a patient injured by a bad doctor's negligence is a VERY bad idea.
I do NOT remember John Edwards doing any such thing. Sounds like something you imagined... like these delusions of yours concerning Rahm Emanual and Bill Maher.
If you want my full take on the issue of trial lawyers and "frivolous" lawsuits... I've answered the question on my blog, which can be read here.
ObamaCare isn't a "big step in the wrong direction"... it just lacks a public option.
dmarks: and yes they are people, WD.
I think this worse than what you've accused BM and RE of. You're using a lie concerning my views on mentally challenged people to score debating points. You should be ashamed dmarks. If you really cared about mentally challenged people as much as you profess you do... you wouldn't be doing this (LYING YOUR ASS OFF).
I don't believe your story about Canadian friend and her mentally challenged daughter who have to come to the US because the daughter is "denied" health care in Canada.
I have a cousin that is mentally challenged (who I do not think of as "subhuman"). She receives all the health care she needs HERE... in the United States.
dmarks, I didn't say a balanced budget was stupid... I said an amendment mandating that the budget must be balanced is stupid. There is a difference.
Balancing the budget right now wouldn't be a good idea (for instance). We need to deficit spend to stimulate the economy. It's a very bad idea to hamstring the government in this manner.
In any case, it was the Republican Cheney who said, "Reagan taught us that deficits don't matter"... REMEMBER?
"We need to deficit spend to stimulate the economy."
How good is a Greekish debt crisis to the economy of a nation? Come on. Deficit spending is bad, period. Find other ways to stimulate the economy. Ways that work (unlike Obama's beastly pork payback that was rushed through, called a "stimulus'.
Yes, I agree, Rand Paul is a nutty POLITICIAN. But do you have ANY evidence that he isn't a first rate physician? Just because people are bad at one thing doesn't mean that they can't excel at another. I mean, just at my frigging facility, I'm really good at cognitive skills training, but I'm exceedingly crappy at arts and crafts. I do the cognitive skills training. Somebody else does the arts and crafts. I personally don't see any reason why Dr. Paul couldn't effectively serve on this board of yours. I mean, I'd rather have him on it than you.
And you do realize, don't you, that all of the graduates from these new med schools will still have to pass the U.S Medical Licensing Exam? I mean, you're not in favor of lowering the standards for THAT, are you?
Why do you keep suggesting I'm in favor of lowering standards? I never suggested anything of the sort. I also never said anything about Randal Paul's skills as a doctor. He should leave Congress and go back to eye-doctoring... that's a good idea.
dmarks: find other ways to stimulate the economy.
Let me guess... cut taxes?
This Greek "debt crisis" is a myth. Greece was screwed first by Goldman Sachs and now they're being screwed by the IMF.
What they should do is reject the "rescue" package and the austerity measures being imposed upon them by the IMF and switch back to their own currency.
They never should have joined the EU to begin with... that was the first big mistake they made.
So, the retiring at age 53 at 80% of their income had NOTHING to do with it?
Will: So, the retiring at age 53 at 80% of their income had NOTHING to do with it?
No, because that isn't true. The information I found says, "the figure of 53 years... comes from a quick comment [on] the site of the New York Times. It has since been repeated by Fox News and [others]. [But the] truth is that the Greek officials have the opportunity to retire after 17.5 years of service, but with a pension of HALF. The figure of 53 years is only a rough average between the number of people who choose this option (most of the time to change careers) and those who continue in public service to obtain the right to a [full] pension... average age of retirement [in Greece] was 61.7 years in 2005, more than Germany, France and Italy, and more also that the average of the 27 countries of the European Union".
I got it from a John Stewart skit.
I actually have a constructive thing to say here. A lot of what most physicians do (90-95%), especially general practitioners, can also be done by nurse practitioners and physicians assistants (P.A.s). If more of the basic stuff can be handed over to them, that I think would be a HUGE help in providing coverage to these 30 million new patients.............And I'm telling you here. As a person who has worked in the healthcare and human services fields for a long time, a nurse practitioner (especially if the person has doctorate degree) is often BETTER than an MD. Seriously.
WD: "They never should have joined the EU to begin with... that was the first big mistake they made."
I disagree with some of what you said, and some quite strongly. But this idea I think has good merit.
wd, 2 of the "proposed solutions" from that list; a) Loosen requirements for entry to medical school and b) improve physician wages. Am I to assume that you're firmly against those 2?
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