I love Real Clear Politics. The site allows me to very quickly get a sense of all sides of an issue as the news and commentary unfold. And, more often than not, their headlines almost alternate. And so you are likely to see:
Drafting Docs - Look for doctors to be conscripted to treat Medicare and Medicaid patients by Kevin D. Williamson writing in the National Review Online
juxtaposed with:
No, There Won’t Be a Doctor Shortage by Drs. of administration of medicine Scott Gottlieb and Ezekiel Emanuel writing in the New York Times
Who ya gonna believe most likely depends on where you stand on the political spectrum. The other guys are ideological jerks pushing an agenda. - either way.
In my case, I naturally think Williamson is one of the most insightful commentators on economic issues and Emanuel is a dyed in the wool Leftie who was involved in Obamacare from the beginning and has been a cheer leader for socialized medicine forever.
Actually, they are both right, sort of.
Williamson points to the laws of supply and demand. They're straightforward and pretty much undeniable.
"The economics is pretty straightforward. Higher prices for medical services are built into the Obamacare model: If you inject a ton of money ... into the demand side of the equation but do little or nothing on the supply side, then you expect higher prices as an expanding river of money chases an amount of goods that is not expanding at the same rate, or that is in some cases fixed or even declining.higher demand + limited supply = higher prices."
"The Obamacare price-fixing authority, the Independent Payment Advisory Board, is explicitly charged with reducing Medicare spending, but it is also legally forbidden to do so by reducing benefits, which leaves physicians’ compensation as pretty much the only meaningful source of cuts. So while higher demand + limited supply = higher prices, higher demand + limited supply + price controls = shortages."
And Emanuel really doesn't deny that there will be a shortage of doctors. What he actually says is that it doesn't matter:
"IN just over a decade the United States will need 130,000 more doctors than medical schools are producing. So says the Association of American Medical Colleges, which warns of a doctor shortage that will drive up wait times, shorten office visits and make it harder for Americans to access the care they need.
"he road to Obamacare has seen its share of speed bumps, as well as big potholes. But a physician shortage is unlikely to be one of its roadblocks."
So, there will be a shortage of doctors, as Williamson points out and Emanuel - - quibbles and obfuscates and changes the subject.
So, when is a shortage not a shortage?
Well, says Emanuel, look at Massachusetts, " Appointment wait times for family physicians, internists, pediatricians, obstetricians and gynecologists, and even specialists like cardiologists, have bounced around since but have not APPRECIABLY INCREASED overall" (emphasis mine)
Williamson made a similar observation: "Massachusetts discovered as much when, after it enacted its state-level version of the ACA, waiting times to see doctors increased dramatically and many physicians simply refused to participate in the program."
A shortage isn't a shortage when it isn't an appreciable shortage. Thanks Zeke!
"Research" also "suggests" that you can get by just fine with less actual treatment: "Research on radiation treatments for breast cancer suggests that 15 treatments can be just as effective as the traditional 30 treatments. Likewise, one larger dose of radiation can be as good at relieving pain from bone metastases as five to 10 separate, smaller treatments."
So, if you aren't given as many appointments, you won't have to wait for as many appointments. Less care means less waiting! Thanks again Zeke!
Dr. Emanuel doesn't see a doctor shortage, but an opportunity! "The opportunity exists to deliver more services and care with fewer physicians" ... because there are fewer physicians available? Isn't that sort of the actual definition of a 'doctor shortage? Yeah, but its not a bug, its a feature of the New Health Care Paradise! Thanks once again Zeke!
But how can we grasp this golden opportunity to deliver more services with fewer physicians?
"Other medical personnel can also expand the reach of physicians to care for a larger population. Nurse practitioners, health aides, pharmacists, dietitians, psychologists and others already care for patients in numerous ways, and their roles should expand in the future."
Williamson agrees, sort of, with this too: "Allowing a larger role for nurse practitioners and other non-physician specialists is a good idea in and of itself, and would have been worthwhile in the absence of Obamacare — if you want prices to go down, expand the supply."
Unfortunately, he isn't following unicorns to Candy Mountain, so he is a little less sanguine about how far this can go.
"But short of a radical deregulation of medical practice (which would have to happen state by state), it is not going to be sufficient to reverse the trends set into motion by the ACA, especially given that so much Medicare compensation is tied to physician-delivered services."
California just changed the law to make abortions by unlicensed non-physicians perfectly legal. Can open heart surgery be far behind? Physicians, we don't need no stinkin' physicians!
But, some things really do have to be done by actual doctors, and as Williamson pointed out, there won't be enough of them who are able to afford to accept government mandated Dollar Store reimbursements.
"So we can either let spending skyrocket and have patients see their doctors, or we can control spending and endure the wrath of Medicare and Medicaid patients who have health-care coverage in theory but limited access to medical care in reality."
"The main obstacle to reducing Medicare and Medicaid spending is the fact that physicians have a choice about whether to participate in the programs. In the long run, the fact that physicians have a choice about whom they see and where they practice is the most significant challenge to the full implementation of Obamacare. The logical thing — politically and economically — is to eliminate that choice. You don’t have to formally nationalize the health-care industry; you just nationalize 40 percent of each physician’s practice and call it his “fair share.”"
But, it won't be all bad news, "Obamacare will almost certainly intensify that trend, producing a surplus of specialists such as cosmetic surgeons even as the nation experiences a shortage of primary-care physicians. The legacy of Democratic health-care reform very well may turn out to be cheaper boob jobs, a fitting comeuppance for the boobs who put this program in place and the boobs who elected them."
Thanks Zeke! You boob.
Drafting Docs - Look for doctors to be conscripted to treat Medicare and Medicaid patients by Kevin D. Williamson writing in the National Review Online
juxtaposed with:
No, There Won’t Be a Doctor Shortage by Drs. of administration of medicine Scott Gottlieb and Ezekiel Emanuel writing in the New York Times
Who ya gonna believe most likely depends on where you stand on the political spectrum. The other guys are ideological jerks pushing an agenda. - either way.
In my case, I naturally think Williamson is one of the most insightful commentators on economic issues and Emanuel is a dyed in the wool Leftie who was involved in Obamacare from the beginning and has been a cheer leader for socialized medicine forever.
Actually, they are both right, sort of.
Williamson points to the laws of supply and demand. They're straightforward and pretty much undeniable.
"The economics is pretty straightforward. Higher prices for medical services are built into the Obamacare model: If you inject a ton of money ... into the demand side of the equation but do little or nothing on the supply side, then you expect higher prices as an expanding river of money chases an amount of goods that is not expanding at the same rate, or that is in some cases fixed or even declining.higher demand + limited supply = higher prices."
"The Obamacare price-fixing authority, the Independent Payment Advisory Board, is explicitly charged with reducing Medicare spending, but it is also legally forbidden to do so by reducing benefits, which leaves physicians’ compensation as pretty much the only meaningful source of cuts. So while higher demand + limited supply = higher prices, higher demand + limited supply + price controls = shortages."
And Emanuel really doesn't deny that there will be a shortage of doctors. What he actually says is that it doesn't matter:
"IN just over a decade the United States will need 130,000 more doctors than medical schools are producing. So says the Association of American Medical Colleges, which warns of a doctor shortage that will drive up wait times, shorten office visits and make it harder for Americans to access the care they need.
"he road to Obamacare has seen its share of speed bumps, as well as big potholes. But a physician shortage is unlikely to be one of its roadblocks."
So, there will be a shortage of doctors, as Williamson points out and Emanuel - - quibbles and obfuscates and changes the subject.
So, when is a shortage not a shortage?
Well, says Emanuel, look at Massachusetts, " Appointment wait times for family physicians, internists, pediatricians, obstetricians and gynecologists, and even specialists like cardiologists, have bounced around since but have not APPRECIABLY INCREASED overall" (emphasis mine)
Williamson made a similar observation: "Massachusetts discovered as much when, after it enacted its state-level version of the ACA, waiting times to see doctors increased dramatically and many physicians simply refused to participate in the program."
A shortage isn't a shortage when it isn't an appreciable shortage. Thanks Zeke!
"Research" also "suggests" that you can get by just fine with less actual treatment: "Research on radiation treatments for breast cancer suggests that 15 treatments can be just as effective as the traditional 30 treatments. Likewise, one larger dose of radiation can be as good at relieving pain from bone metastases as five to 10 separate, smaller treatments."
So, if you aren't given as many appointments, you won't have to wait for as many appointments. Less care means less waiting! Thanks again Zeke!
Dr. Emanuel doesn't see a doctor shortage, but an opportunity! "The opportunity exists to deliver more services and care with fewer physicians" ... because there are fewer physicians available? Isn't that sort of the actual definition of a 'doctor shortage? Yeah, but its not a bug, its a feature of the New Health Care Paradise! Thanks once again Zeke!
But how can we grasp this golden opportunity to deliver more services with fewer physicians?
"Other medical personnel can also expand the reach of physicians to care for a larger population. Nurse practitioners, health aides, pharmacists, dietitians, psychologists and others already care for patients in numerous ways, and their roles should expand in the future."
Williamson agrees, sort of, with this too: "Allowing a larger role for nurse practitioners and other non-physician specialists is a good idea in and of itself, and would have been worthwhile in the absence of Obamacare — if you want prices to go down, expand the supply."
Unfortunately, he isn't following unicorns to Candy Mountain, so he is a little less sanguine about how far this can go.
"But short of a radical deregulation of medical practice (which would have to happen state by state), it is not going to be sufficient to reverse the trends set into motion by the ACA, especially given that so much Medicare compensation is tied to physician-delivered services."
California just changed the law to make abortions by unlicensed non-physicians perfectly legal. Can open heart surgery be far behind? Physicians, we don't need no stinkin' physicians!
But, some things really do have to be done by actual doctors, and as Williamson pointed out, there won't be enough of them who are able to afford to accept government mandated Dollar Store reimbursements.
"So we can either let spending skyrocket and have patients see their doctors, or we can control spending and endure the wrath of Medicare and Medicaid patients who have health-care coverage in theory but limited access to medical care in reality."
"The main obstacle to reducing Medicare and Medicaid spending is the fact that physicians have a choice about whether to participate in the programs. In the long run, the fact that physicians have a choice about whom they see and where they practice is the most significant challenge to the full implementation of Obamacare. The logical thing — politically and economically — is to eliminate that choice. You don’t have to formally nationalize the health-care industry; you just nationalize 40 percent of each physician’s practice and call it his “fair share.”"
But, it won't be all bad news, "Obamacare will almost certainly intensify that trend, producing a surplus of specialists such as cosmetic surgeons even as the nation experiences a shortage of primary-care physicians. The legacy of Democratic health-care reform very well may turn out to be cheaper boob jobs, a fitting comeuppance for the boobs who put this program in place and the boobs who elected them."
Thanks Zeke! You boob.
