Obama Hires Mystery Shoppers to Spy on Doctors...What next?

@georgeob1,

The shortage of doctors in rural areas (at least) have been around way before the administration did anything.

Shortage of Doctors Affects Rural U.S.

Medical miscalculation creates doctor shortage

1 Reply

@revelette,

I didn't suggest that Obama created the shortage of doctors in rural areas (and others as well). Rather, I wrote that he has been late recognizing it - after championing legislation that will create enormous increases in demand (thereby worsening the shortage) and, at the same time, significant restrictions in the fees paid for services - all with the assurance that "You can keep your present insurance if you like it." The basic economic contradictions here are a serious cause for general concern - and an indicator of the incompetence of the self styled "progressives" who created this monster and who propose to tell us all how to live.

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@georgeob1,

Quote:

I didn't suggest that Obama created the shortage of doctors in rural areas (and others as well).

Yes you did in your previous post in which I replied.

Quote:

It is only a possibility, and there is no direct evidence for it (of which I am aware) , however, the Administration is faced with the prospect of widespread practicioner resistance to potential large reductions in reimbursement rates for Medicare and Medicaid. Moreover it appears the Administration has recently woken up to the problem of a shortage of general practitioners amng Medical Doctors relative to the new entitlements they have created.

You said the administration has only now woken up the problem of shortage of doctors relative to the new entitlements they have created. Unless you meant that they only realized the shortage of doctors because of the passing of the health care act? Actually the administration has been aware of the problem for some time as the first link indicated.

Quote:

Rather, I wrote that he has been late recognizing it - after championing legislation that will create enormous increases in demand (thereby worsening the shortage)

The answer to the shortage of doctors problem is surely not to have fewer people having access to doctors and medical attention? What if in a better world everyone could afford private health care, would we not have the same problem?

Quote:

significant restrictions in the fees paid for services

What are these restrictions in the fees paid for services which I suppose you mean contributed to the problem of doctor shortages?

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@georgeob1,

georgeob1 wrote:

- after championing legislation that will create enormous increases in demand (thereby worsening the shortage)

ahhh, I see. It's problematic for you that more people might get access to treatment.

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The US under our present private healthcare system has a worse doctor-patient ratio than any of the major single-payer health systems in other countries.That means single payer health systems,, which according to the reactionaries here short change doctors still somehow mangage to find MORE doctors per capita than we do. How can that be?

One reason is that the medical societies and medical organizations have for decades acted in what seems to be restraint of trade by sharply limiting admissions to medical schools and limiting the number of medical school slots for students, which has the not coincidental effect of limiting the supply of doctors and driving up the fees they can charge due to demand for their services.

Expand medical schools. Expand financial support for medical students. Do something similar to the armed service programs we ALREADY fund-- get government support and you commit to a period of navy doctoring or dentistry on a battleship. Get government financial aid and not be in hock to a bank for a decade when you get out, and commit to three or four years service (and of course get paid well for it in comparison with other jobs), in an area that's underserved because all the private doctors want to work in New York City.

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@revelette,

You would do well to read the words I wrote, instead of those you apparently imagine. I indicated that the administration appears to have only recently woken up to a shortage in medical practitioners that their health care legislation has likely made worse by both expanding access to care and reducing government payments for it. (You may recall they counted significant reimbursement rate reductions for Medicare services, as well as the elimination of Medicare Advantage, as part of the "savings" attendant to the Obamacare legislation.)

It is one thing for a government to vacuously declare that goods and services produced by others are now "available" to everyone, but quite another to actually deliver it. It is even worse if, in doing so, the government screws up the market for the delivery of those services in the process. The perennial political debates in the UK and Canada about their government run health care systyems are reminders that, even with populations of sheep accustomed to life in the pasture, the real delivery of promised services is a difficult chore, fraught with difficulties all around.

The idea that central planning can expand the supply of something while reducing its cost by legislative or administrative fiat, without significant technological and productivity innovation, defies everything we know about economics.

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@georgeob1,

Quote:

The perennial political debates in the UK and Canada about their government run health care systyems are reminders that, even with populations of sheep accustomed to life in the pasture, the real delivery of promised services is a difficult chore, fraught with difficulties all around.

AND YET, their system is beloved by their populace, consistently supported in every poll. The CONSERVATIVES in these countries fight to protect their socialized systems.

This doesn't quite match up with your constant doom-and-gloom descriptions of their systems. If it's such a perilous situation, why do their systems consistently receive so much support from the population?

Quote:

The idea that central planning can expand the supply of something while reducing its cost by legislative or administrative fiat, without significant technological and productivity innovation, defies everything we know about economics.

This statement presupposes that you actually do know something about economics; which, given your stated desire to see our country enter default, I find to be somewhat hard to swallow. I think you know a lot more about ideology than economics...

Cycloptichorn

1 Reply

re georgeob:
and you think it's less fraught with difficulty under our present malfunctioning private health care system?

As I recall, the debate in Canada was about a 6% increase in health care premiums to maintain solvency. Which, considering they only pay about 60% of what we do per capita, for their single payer system, was about equivalent to a 3.6% increase in the States. When was the last time your health insurance costs in the US only increased 3.6%?

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@ehBeth,

ehBeth wrote:

georgeob1 wrote:
- after championing legislation that will create enormous increases in demand (thereby worsening the shortage)

ahhh, I see. It's problematic for you that more people might get access to treatment.

I think you know beter than that. What is problematic for me is a government that promises greater access to care and, in the process, actually harms the economic structure that provides that care - in addition to putting everything at risk by uncontrolled spending.

1 Reply

@georgeob1,

georgeob1 wrote:

ehBeth wrote:

georgeob1 wrote:
- after championing legislation that will create enormous increases in demand (thereby worsening the shortage)

ahhh, I see. It's problematic for you that more people might get access to treatment.

I think you know beter than that. What is problematic for me is a government that promises greater access to care and, in the process, actually harms the economic structure that provides that care - in addition to putting everything at risk by uncontrolled spending.

Highly ironic, considering that the three prime methods for controlling spending (the Public Option, the IPAB, and negotiating for drug prices in Medicare) proposed by the Dems, are all things that your party has bitterly complained about, fought against and was successful in some cases in removing.

It's hard to have a successful program to take care of these issues when the other party is hell-bent on sabotaging the entire thing. Which is exactly what the Republicans have tried to do over the last couple of years.

Cycloptichorn

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@Cycloptichorn,

Clearly Cyclo knows better than us all. Floods of new doctors will suddenly respond to the attractive incentives provided by reams of arcane new government regulations and requirements for bureaucratically determined prices for their services. The usual relationship of supply, demand, prices and productivity will be suspended due to some progressive pixie dust that the sainted Obama has sprinkled over us all.

Perhaps he hopes that the evident contradictions in the new HC system will eventually be worked out by ever more intrusive central management and control. The casualty will be our freedom.

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@georgeob1,

Sarcasm is unbecoming when you take it to such extremes. It would have been more effective if you'd limited it to a single, cutting line. Now you just come off as churlish.

It's clear that, health reform bill or no, we're going to need more doctors and specifically more GPs in the future. We would be well served to take steps to increase the number of available doctors, in the ways that MJ said above - through greater access to schools here, greater gov't funding for people to attend schools, a lessening of the power of the AMA to keep doctors rare, and increased immigration of foreign doctors who wish to come to America.

This problem was not created by the ACA and it's ridiculous to blame it on Obama. But don't let that stop ya.

Quote:

Perhaps he hopes that the evident contradictions in the new HC system will eventually be worked out by ever more intrusive central management and control. The casualty will be our freedom.

I think the real casualty is in the words 'freedom' and 'tyranny' themselves, which have suffered a great deal of abuse at your hands over the last two years. You basically use them to mean 'whatever I think is the right way to do things is freedom, and whatever I disagree with, tyranny.' It's not convincing.

I have a great post cooking for ya, george, which uses multiple polls (all from 2011) to show that not only do majorities of people want to see tax raises in order to help solve our budget woes, the vast majority of Americans do not blame Obama for the recession or believe that he's prolonged it. This is in direct contradiction to your projected 'growing amounts' of people, which I believe you have simply invented by taking your own thoughts and magically extending them to the populace around ya.

Cycloptichorn

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@georgeob1,

georgeob1 wrote:

The idea that central planning can expand the supply of something while reducing its cost by legislative or administrative fiat, without significant technological and productivity innovation, defies everything we know about economics.

Perhaps it defies everything you know about economics. But this would only prove that you missed the Economics-101 classes when your professor talked about market failure. Students who did attend those classes know better: Government intervention can improve on market outcomes when market signals are distorted by oligopolies, asymmetric information, or externalities. And as it happens, all these distortions occur in the markets for health care and health insurance.

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georgeob, I suggest you actually look at single payer systems around the world, most of which have been in operation for around half a century, some more than a century (Germany's--which, I might add, was started by a semi-authoriatarian right wing monarchy). They all cost roughly half per capita of what the US system costs. They all consume a much smaller percentage of GDP. The combined administrative costs to providers and doctors is about a third of the costs in the States. Longevity in those countries is higher (we rank in the forties). Public health metrics are much better (there are a couple third world countries that beat us). Doctor-patient ratios are better than in the USi.e. despite lower payments they still somehow get more doctors than we do. And patient satisfaction is higher. Those arent speculation. Those are the facts, validated by actual experience rather than conservative ideological rants.

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@MontereyJack,

MontereyJack wrote:

georgeob, I suggest you actually look at single payer systems around the world, most of which have been in operation for around half a century, some more than a century (Germany's--which, I might add, was started by a semi-authoriatarian right wing monarchy). They all cost roughly half per capita of what the US system costs. They all consume a much smaller percentage of GDP. The combined administrative costs to providers and doctors is about a third of the costs in the States. Longevity in those countries is higher (we rank in the forties). Public health metrics are much better (there are a couple third world countries that beat us). Doctor-patient ratios are better than in the US. And patient satisfaction is higher. Those arent speculation. Those are the facts, validated by actual experience rather than conservative ideological rants.

Sure, but George is unconcerned about numbers which compare TOTAL population outcomes, because what he and his ideological kind are interested in are PEAK outcomes - how those who have the most money fare. And in America, the rich do quite well when it comes to all the factors you listed above. This is the typical Conservative response to comparative metrics such as the ones you cite.

And that's all they are concerned about. Greater access to HC for everyone isn't even seen as a good thing by them - it's seen as a greater expense for what they consider to be no good reason at all.

Cycloptichorn

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re georgeob
There was a news story a few months ago about one of the rising economies which was working on installing a single payer system for their country. They were visiting all the other countries that had such systems. seeing what worked well and what the problems were, before they started theirs. If the American exceptionalists weren't so bull-headed and certain America did everything better than everybody else and had nothing to learn from anybody else, we might try something similar. And learn something that other countries have known for years.

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@MontereyJack,

Except that pooling our funds to provide benefits for individuals is "socialism" and that's evil, ya know.

Just don't anyone look at the Interstate Highway system.

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I will readily confess to a strong preference for individual freedom and my own choices in as many elements of my life as possible. I raised four children all of whom attended parochial schools - two attended a private university (Georgetown) and two public ones (University of VA & The Naval Academy).

I did a career in the Navy and was experienced with the decidedly second rate health care it provided to families. Since then I have been employed in the Private sector with health benefits typical of most major businesses - it's a lot better than what the Navy provided, and I have a choice in the providers I use.

Lots of points raised here;
=> revelette insists on quibbling over his rather unique interpretation of otherwise clear and plain words. (1) We did have a shortage of doctors that predated the Obamacare legislation. (2) The legislation promised to significantly increase demand for health care without doing anything to improve either the supply or ther productivity of the caregivers - thereby exacerbating the shortage. (3) Worse, parallel actions to reduce the reimbursement rtates for Medicare & Medicaid (in order to create the illusion that the "new" system would be cheaper), and the flood of chickenshit regulations associated with the new law, are driving existing practitioners out of the market, further worsening an already bad situation.

=> Thomas reminds me of government's beneficial role in correcting market distortions;

Thomas wrote:

Government intervention can improve on market outcomes when market signals are distorted by oligopolies, asymmetric information, or externalities. And as it happens, all these distortions occur in the markets for health care and health insurance.

He is correct, of course. However the government "corrections" themselves often create their own worse distortions, as for example with agricultural or "clean" energy subsidies. The AMA is not either the only or the chief force limiting new medical care providers. (Governments at all levels limit the construction of new hospitals or opening of new clinisc as a means of limiting short term claims on their entitlement programs.) Moreover the AMA's actions are no different than those of labor unions that seek to limit the supply of workers with access to "their" jobs (try getting a job as a carpenter in New York if you don't have a relative in the union or a friend in the Mafia). I would like to see the freest, least distorted market for health care services we can get. Obamacare is a huge market distortion.

=> Monterey Jack is confused about single-payer HC systems. In the first place Germany does not have a single payer system. In the second place the attributed costs of government paid systems are measured in terms of government, not real, accounting. Legal, tort claim, enforcement and broad administrative costs, as well as the cost of capital are not included in the published figures. The comparisons are themselves distorted. We probably do pay more here on a unit cost than (say) in the UK or Canada. However, our outcomes for patients diagnosed with a host of serious diseases are far better than theirs. An excellent way of lowering average costs with the least effect on average mortality is to deny care to those with the highest expected mortality. Makes sense on the average, but not to the individual involved. That is precisely what is done in the UK and Canada with their controlled access to specialists and enforced limitations on their supply.

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@Thomas,

The operative word is "can."

Your economic professor may have told you they will improve on market outcomes, but that's the problem with academic economics.

To the extent that a self-organizing system is put off kilter by human focused intervention, there is certainly no assurance that further or counter human focused intervention can set it right again.

It is highly unlikely that we will see a truly free market place, and I'm not about to argue we should, but the role of government in the market place is to reduce the severity of distortions with as light a touch as possible.

In this regard the government needs to be a surgeon with a scalpel, not a ham fisted butcher with a cleaver.

Once governments decide that they can and should direct the market place rather than simply protecting its autonomy, things go batshit.

1 Reply

@Finn dAbuzz,

Finn dAbuzz wrote:

The operative word is "can."

Which is enough to refute georgeob1's claim that this idea "defies everything we know about economics." This claim was simply false, and that's what I was responding to. If George wants to recruit the authority of economics to support his argument, he has to play by the rules of economics. He has to accept its finding that government intervention beats free markets under certain conditions, which the healthcare industry happens to meet. You, on the other hand, apparently don't think much of academic economics. Accordingly, you don't bolster your claims with the authority of that field. That's alright with me. Unlike George, you're not trying to have it both ways.

Finn dAbuzz wrote:

To the extent that a self-organizing system is put off kilter by human focused intervention, there is certainly no assurance that further or counter human focused intervention can set it right again.

In politics, there never is any assurance for anything. But in the case of healthcare, we have pretty good empirical evidence from other countries. This evidence is unkind to free-market fundamentalism. And it confirms what we would expect under a conventional economic analysis of the healthcare sector's assortment of market failures.

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Obama Hires Mystery Shoppers to Spy on Doctors...What next?

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