Doctor shortage confounds Obama’s socialization plans for health care

posted at 2:55 pm on April 28, 2009 by Ed Morrissey

Barack Obama’s plans to nationalize the health-care industry has run into one major snag — a lack of doctors.  Shortages in both primary-care and specialist physicians has made it more difficult for Medicare patients to get care, but thus far, the administration has drawn the wrong lessons from the crisis.  They’re offering the hair of the dog as a solution:

To cope with the growing shortage, federal officials are considering several proposals. One would increase enrollment in medical schools and residency training programs. Another would encourage greater use of nurse practitioners and physician assistants. A third would expand the National Health Service Corps, which deploys doctors and nurses in rural areas and poor neighborhoods.

Senator Max Baucus, a Montana Democrat and chairman of the Finance Committee, said Medicare payments were skewed against primary care doctors — the very ones needed to coordinate the care of older people with chronic conditions like congestive heart failure, diabetes and Alzheimer’s disease.

“Primary care physicians are grossly underpaid compared with many specialists,” said Mr. Baucus, who vowed to increase primary care payments as part of legislation to overhaul the health care system.

The Medicare Payment Advisory Commission, an independent federal panel, has recommended an increase of up to 10 percent in the payment for many primary care services, including office visits. To offset the cost, it said, Congress should reduce payments for other services, an idea that riles many specialists.

All of this is entirely, and dully, predictable.  Ten days ago, I wrote how attempts to control costs in Medicare has led to an even more pronounced shortage of physicians who will accept Medicare patients.  The government wants to disconnect prices from costs and cap the former, which eventually makes providing the care more costly than simply opting out of the network.  That kind of market pressure inevitably creates flight of the best physicians — the ones who can attract and keep the most paying customers — leaving Medicare patients with a network of more mediocre providers, if any at all.

The solution offered by Obama and Baucus would exacerbate the problem.  Instead of creating a profit incentive by relying more on market forces, they want to divide up the finite government subsidies to favor primary care physicians over specialists.  This will result in fewer specialists, who provide acute care for specific conditions, such as nephrologists for renal failure, oncologists to treat cancer, and so on.  The lack of doctors in these specialties will mean that sick people get sicker and stay sicker longer, and eventually will start dying at higher rates while waiting to see a disappearing roster of physicians.

This is exactly what has happened in Canada and the UK, two systems that use explicitly single-payer systems to regulate compensation for services.  Because they do not provide enough extra compensation to specialists and surgeons, both countries have enough general-practice doctors but significant shortages of specialists, who won’t spend the time or the fortunes to specialize because the investment never pays off.  It takes months for patients with acute, serious illnesses to get an appointment with the overburdened specialists still left in the system, months to get tests completed, and months more to get treatments started.

Dr. Peter J. Mandell, a spokesman for the American Association of Orthopaedic Surgeons, said: “We have no problem with financial incentives for primary care. We do have a problem with doing it in a budget-neutral way.

“If there’s less money for hip and knee replacements, fewer of them will be done for people who need them.”

In fact, that’s exactly why we’re seeing the problem in the Medicare and Medicaid networks.  The new proposals from the Obama administration will amplify those pressures, not relieve them.


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Obama represented Rezco in chicago. Rezco let the heat be turned off in the Chicago winters. what happened? Nothing. Obama voted against the born alive Infant protection act. Haviing given 2 examples, do you think a shortage of doctors is relevant to obama? Not in this lifetime. He also will lose a lot of Christian docs that refuse abortion referrals. Remember a certified narcissist does not care.

seven on April 28, 2009 at 4:10 PM

It could be they will change their minds when they see the he** Obama is planning for our health care system.

That would be horrible, because they really are two of the best and the brightest this country has to offer the medical world. (At least I think so, but of course I’m their mom)

Marybeth on April 28, 2009 at 4:02 PM

I hope your children have good and long careers caring for the sick.

And remember: Mother knows best.

Loxodonta on April 28, 2009 at 4:13 PM

tru2tx on April 28, 2009 at 3:30 PM

Interesting scenario, but not very realistic.

Actually, when you go to the hospital, look at the red outlets & light switches. Those are the ones connected to emergency generator backup as well, so critical equipment keeps going during a power failure.

cs89 on April 28, 2009 at 4:16 PM

My wife thinks Alaska is too cold, and I think Texas is too hot. I guess I’m scr#wed.

MarkTheGreat on April 28, 2009 at 3:48 PM

This same argument takes place in my house on a near daily basis.

myrenovations on April 28, 2009 at 3:50 PM

So in August go to Alaska. Or buy a house in Texas with a pool.
We pretty much stay wet from May until September.

izoneguy on April 28, 2009 at 4:16 PM

Obama is an extreme narcissist. He could care less if the system works. He’s all about his ability to achieve the system of his utopia. The man is also a blatent communist. He’ll step over those carcuses rotting in the gutter.

Griz on April 28, 2009 at 4:20 PM

THANK. GOD. Let’s just pray more go galt until we can get these people out and reeducate a new crop of conservatives. It’s all about holding back the tide at this point.

Mommypundit on April 28, 2009 at 4:21 PM

I will probably pick three because its only $2,000 or so to fly to the Far East.

dwford on April 28, 2009 at 3:27 PM

You have forgotten to account for carbon rationing.
It’s highly unlikely you will be permitted to fly anywhere.

MarkTheGreat on April 28, 2009 at 4:22 PM

As an old friend of mine used to say, “do you want to see the highest paid doctor, or the lowest paid doctor?” The answer is obvious to most people, unless you’re a leftist. No worrys folks. Obama and his socialist minions will just pass a law mandating that all physicians participate in the new nationalized health care system.

Then they’ll open up the floodgates so foreign doctors can rush in to fill whatever void exists. Better brush up on your Urdu and Farsi because you’re going to need it. Of course, they’ll also wipe out all the private health plans so you’ll have nowhere else to go unless you want to leave the country. We wouldn’t want any disparity of care now would we? Wouldn’t be right. Same shitty care for everyone.

eyedoc on April 28, 2009 at 4:23 PM

Geez.

Couple this with the projected nursing shortage of 600,000 in a few years (courtesy F&F), and Hussein will be the biggest mass murderer since Stalin.

But it’s all in the name of equal access, so it’s okay.

madmonkphotog on April 28, 2009 at 4:34 PM

Of course, they’ll also wipe out all the private health plans so you’ll have nowhere else to go unless you want to leave the country. We wouldn’t want any disparity of care now would we? Wouldn’t be right. Same shitty care for everyone.

eyedoc on April 28, 2009 at 4:23 PM

Even my 15-year-old who hates politcs gets this. He supported McCain because he didn’t want to suffer with shitty government run health care. That, and he was already outraged by the $35,000 he owes in national debt. Now it’s up to $50,000 and he is PISSED. And guess what? He will be eligible to vote in 2012.

rockmom on April 28, 2009 at 4:48 PM

I know a doctor who is going to law school, since there is no money in medicine.

Tim Burton on April 28, 2009 at 4:54 PM

Don’t worry they’ll just hire more Indians. There are hundreds of ready to serve Indian doctors who’ll do the job for half the dollars Americans get for the same job; now US will be full of them.

Don’t you know the Chicago Indian machine is fully behind Obama?They’ve already got him attack Pakistan, the stuff most of them wanted from America for a long time and it’s already a bigger mess than it was. If you thought 65,000 annual H1Bs were bad, you ain’t seen nothing yet. H1Bs will be capped at 10 times more.

promachus on April 28, 2009 at 4:59 PM

OUT: Hope! Change!

IN: Turning America into a s**thole, one day at a time!

capitalist piglet on April 28, 2009 at 5:00 PM

rockmom on April 28, 2009 at 4:48 PM

Hear ya… my twins turned 18 last month… both are angry, and vocal about it… and talking to their friends…

I introduced some of their friends to the Federalist Papers awhile back… wow… talk about opening some eyes… they had heard of them, but had no idea what was in them.

Fical Con/ Libertarian could be the “next” cool…

Romeo13 on April 28, 2009 at 5:11 PM

Just wait til the doctors and nurses are forced into unionization, and the union decides there needs to be a strike. Try getting care then. They have this in Canada.

txmomof6 on April 28, 2009 at 5:13 PM

Perfect. The (obviously Gov’t) doc in the pic has the chest xray backward.

mikeyboss on April 28, 2009 at 5:13 PM

The solution is easy for Leftists… Death…

Abort babies, deny care, elderly get the “eskimo plan”

phreshone on April 28, 2009 at 5:15 PM

Perfect. The (obviously Gov’t) doc in the pic has the chest xray backward.

mikeyboss on April 28, 2009 at 5:13 PM

Well… ya see… the guy said his back hurt… so….

Romeo13 on April 28, 2009 at 5:18 PM

If Obama nationalizes health care, is he going to make it illegal to sue government doctors for malpractice and piss off the trial lawyer lobby? If not, who would be stupid enough to be a doctor in BO-world?

I suppose the obvious solution (“obvious” if you’re a liberal) is for the government to provide the malpractice insurance. That way the trial lawyers will be taking their money directly from the treasury. A logical extension would be for government “subsidies” (a.k.a.: protection payments) directly to lawyers that don’t sue doctors.

What a wonderful world we’re going to be living in.

Socratease on April 28, 2009 at 5:21 PM

How long will it take for obama’s bad decisions to catch up with him—and–how long will it take for people to notice.

jeanie on April 28, 2009 at 5:22 PM

Too long

txmomof6 on April 28, 2009 at 5:28 PM

How long will it take for obama’s bad decisions to catch up with him—and–how long will it take for people to notice.

jeanie on April 28, 2009 at 5:22 PM

It doesn’t matter. Like social security, or welfare, or medicare, once the bad decisions are made they’re undoable, forever.

Blacklake on April 28, 2009 at 5:33 PM

Totally Off Topic, but I feel like I am living in the Twilight Zone instead of America with the healthcare debate (or lack thereof by the Democrats), and then I was so disturbed today to hear from a friend that when Obama spoke at Georgetown recently, he insisted that they cover up the inscription with Jesus’ name on the crucifix or he would not speak. They complied. So much for the Society of Jesus. Guess it is easy for the chilling of all forms of freedom in the new America we live in.

txmomof6 on April 28, 2009 at 5:39 PM

The real question here is

“When the medical profession totally unionizes, will the DINOS (Democrat in Name Only Socialists) start paying top dollar to the medical union buddies like they do for construction, schools, etc.”

Currently, Medicaid/SCHIP and Medicare pay about 40% or less on many procedures, less than it costs to provide the care. Hence, many clinics ration taxpayer care to a couple patients a week or less.

The reality the ObamaCare clowns don’t realize is you can’t force doctors to provide care for lower than market rates. ObamaCare might provide coverage for everyone ten times over, but few if any doctors will see you under ObamaCare, at least not without a highly rationed wait.

Don’t believe me? Feel free to sign up so you can wait and see yourself.

droofus on April 28, 2009 at 5:40 PM

If Obama nationalizes health care, is he going to make it illegal to sue government doctors for malpractice and piss off the trial lawyer lobby? If not, who would be stupid enough to be a doctor in BO-world?

No, but the standard of care will be so much lower than it is today that proving malpractice will be virtually impossible. See, everything will be just fine.

eyedoc on April 28, 2009 at 5:45 PM

Another would encourage greater use of nurse practitioners and physician assistants.

NO, NO, and NO to more nurse-practitioners!

My mother was suffering from a chronic cough last December, and needed a referral to a lung doctor, and the doctor she was supposed to see was replaced by a nurse-practitioner, who mis-diagnosed her with pneumonia, and prescribed Levaquin.

Within a few days of taking Levaquin, my mother’s lungs were filling up with fluid, and her muscles wasted away, and she could hardly breathe, and she was hospitalized for what was mistakenly diagnosed as “congestive heart failure”, but we believe that it was a horrible side-effect of Levaquin that made the capillaries leak in her lungs.

The doctors at the hospital were so preoccupied with the fluid in the lungs, that they missed a cancer growing in the upper part of her lung for two months. They finally found it in late February and gave her chemotherapy, but it was too late, and she passed away last March 24.

It’s hard to know for sure, but if that nurse-practitioner hadn’t given her Levaquin, the cancer might have been found earlier, and my Mom would have been stronger to accept chemotherapy treatment, and she might still be alive today.

Nurse-practitioners may be able to treat a child’s sniffles or a sprained ankle, but their competence is limited, and can make terrible errors in case of serious illness. They should NOT be trusted to have the same competence as doctors without adequate training!

Steve Z on April 28, 2009 at 6:45 PM

These people may be smart (I don’t believe they are, but let’s assume for the sake of argument that they are), but they know NOTHING about health care.

Would we ask a bunch of physicians to redesign our Justice System?

No, but if we did, I’d wager dollars to doughnuts that they would do one HELLUVA better job doing that, than a bunch of worthless, corrupt and incompetent lawyers will do redesigning health care.

NoDonkey on April 28, 2009 at 6:46 PM

In the end though, the untimely death of many old people due to rationed health care may reduce our carbon-footprints, and save on Social Security as well.

As an older person, why am I not thrilled?

Dhuka on April 28, 2009 at 7:29 PM

You’ve got this one wrong HotAir.

The proposal that government incentivise primary care is not a socialist or left-wing position, but rather a middle of the road one.

Government could and should tie medical school funding to graduating more Family docs, etc. Raising the reimbursement of primary care specialties will not recreate the Canadian system. In many places there is a glut of specialty care. Common medical problems wind up being taken care of by overpriced docs.

Bruce

baruchadam on April 28, 2009 at 9:05 PM

BHO is continually saying “These are not my opinions but experts from both parties”. If these so called experts keep coming up with such insane ideas about the economy and social ills it makes me wonder what the hell is being taught in our schools and universities. My next question is who the hell are these idiots followed by “Are any of these idiots running AIG, GMC, Chrysler etc”.

Why are we in this hand basket and where the hell are we going?

vulcannomad on April 28, 2009 at 9:16 PM

All he has to do is demand that doctors accept his underfunded chits. Do I see Obama Franks Waters LLC II coming for the medical profession, as it did for real estate?

If I were a doctor, I’d be seriously considering not being one. There’s more money to be made as a lawyer nowadays.

unclesmrgol on April 28, 2009 at 11:06 PM

If you get sick, who would you rather see, a doctor with 4 years of medical school and 4 years of residency, or a nurse practitioner?

Sgt. Hartman on April 28, 2009 at 3:18 PM

Hate to get all up in yer arse about this, but NP’s have 4 year degrees, usually a masters which equals 2 more years of school. and most nurses who become NP have at least three to four years of hardcore clinical work behind them (nights, evenings, day shifts, etc.). They aren’t as well trained as physicians, to be sure, but an NP is just as competent as an MD (if not more). Trust me, I’ve saved just as many lives (if not more) than most doctors because nurses are the backbone of any clinician’s competency.
/steps off soapbox.

mjk on April 28, 2009 at 3:23 PM

=================
might be able to infer this for a family practitioner but not Internal Medicine or way off if comparing to a specialist such as a pulmonologist, or nephrologist. Diagnostic skills from signs and symptoms….maybe…….but diagnostic skills when reviewing labs, CT scan. Differential diagnosis problem list is much shorter with NP or PA compared to Internal Medicine. Sometimes we need to find a zebra when all we see is a horse.

scruplesrx on April 29, 2009 at 1:58 AM

I know personally 3 surgeons and one nephrologist who have retired in the last 7-8 months. (retired early)

scruplesrx on April 29, 2009 at 2:04 AM

With America’s health care system gone, the world will plummet into a health care Dark Age. Deaths from preventable and easily treatable diseases will skyrocket. Medical marvels and innovations will disappear.

And all the while, no one will care to wonder why America was number one last year and tied in last the next.

Must’ve been Bush’s fault.

amkun on April 29, 2009 at 5:56 AM

The plan worked out in a bi-partisan committee of all democrats is to cerify ACORN members in good standing as physicans and raise their government payments by $10,000 per week. This will alleviate the shortage of Doctors and reduce unemployment at the same time. The number of patients treated will increase as dramatically as the number of voters registered did. The more serious the illness the more pickets in front of their hospital rooms which will insure proper treatment. The benefit just seems endless!

duncantwn on April 29, 2009 at 7:54 AM

The plan worked out in a bi-partisan committee of all democrats is to certify ACORN members in good standing as physicians and raise their government payments by $10,000 per week. This will alleviate the shortage of Doctors and reduce unemployment at the same time. The number of patients treated will increase as dramatically as the number of voters registered did. The more serious the illness the more pickets in front of their hospital rooms which will insure proper treatment. The benefit just seems endless!

duncantwn on April 29, 2009 at 8:28 AM

I refuse to believe that a majority of Democrats are stupid enough to want to push America into a health care system that has failed repeatedly in other nations. This has to be the far left loonies pushing this. Surely with even a super majority, this won’t happen.

We are short on doctors because of the sky high cost of earning a medical degree. If you’ve got to mix in some socialism to make the left happy, do it by haveing the government build and operate some medical schools, lowering the cost of getting a medical degree. That should eventually get our “Dr” population growing and for God’s sake put some realistic caps on mal-practice litigation.

Ernest on April 29, 2009 at 9:51 AM

The proposal that government incentivise primary care is not a socialist or left-wing position, but rather a middle of the road one.

Government could and should tie medical school funding to graduating more Family docs, etc.

Really? And how exactly would you propose they do that? I paid $120,000 to go to medical school 20 years ago, and it costs way more than that now. Are you honestly telling me that after spending all of that money (which after interest winds up being about twice as much) the government should be able to force me to enter a medical field that I have no interest in entering? And you don’t think that kind of central planning is socialism? That’s demented.

Raising the reimbursement of primary care specialties will not recreate the Canadian system. In many places there is a glut of specialty care. Common medical problems wind up being taken care of by overpriced docs.

You’re dreaming if you think they’ll be any kind of increased reimbursement for primary care doctors. And the idea that there is a glut of medical specialists has been disproved many times. Plus, physicians have taken massive pay cuts over the past 10-15 years or so due to rapidly falling government reimbursement, and there’s no end in sight. There are no “overpriced docs”.

eyedoc on April 29, 2009 at 10:07 AM

I actually work in the nhs and have done for 20 years.
In no way do i blindly defend it.

However we believe that health should not be based on ability to pay.

Following ww2,men from all of society fought together but on return their was vast differences in care for defending their country.

The percentage of people waiting under 8 weeks was 96.8%. This is measured from G.P referral to treatment including surgery.
In my hospital it is 4.6%. The target is 18 weeks.People do have choice,we compete for patients. I work in a foundation hospital which is locally funded.

We sell services ,and have private industry involved. The money made goes back into the hospital.
Not everything is ‘free’, there is a standard prescription cost of £6.80 so that people do take the treatment.

To suggest that we are all in a line waiting for Stalin to feed us shows no insight to the health system’s across Europe.

France and Sweden’s service seems to be better.

The N.H.S has broad support from all types of people in the U.K ,it is not a left wing policy.

This is not big government control. Policy reflects society in a democracy.

There is a fundamental belief that society benefits more from this support.To lose your job,your house never mind your life when you become ill is shocking .

Doctors phoning insurance agencies to ask which tests they can do is bewildering to us.

I am not saying we have got it right, but nobody is queing up to copy the U.S model.

That is not an insult, i would explain the pro’s and con’s as a fact finding discussion,however don’t just attack me for having a different view.

mags on April 29, 2009 at 12:16 PM

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