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June 29, 2012


Almost all of the socialized medicine countries listed above by Blogger Brian have very high taxation rates and despite that many of them are in financial arrears, broke or going broke.

At any rate passions run high on both sides of the debate...

A Surgeon Cuts to the Heart of the Ob*maCare Nightmare
By Stella Paul

The day the Supreme Court ruled in favor of Ob*maCare, a friend called me. He's an extremely dedicated, much-loved surgeon, and he was frustrated and livid in equal measure.

"I've actually had a lot of experience working in all different types of environments," he began. "I've worked in a government-run socialized medical care system, and I saw the waste and inefficiency.

"The longer people worked in that system, the less work they wanted to do, because the more you wanted to do, the more they dumped on you. So after a while you stop doing it, because they're not paying you to do more. Why should you do a difficult case, a difficult surgery that will take you hours and hours to do?

"You might start out wanting to do it, but after a while, you just run out of energy, because there's no incentive. You'd have to be a superhuman being to continue to work in that system and not be worn down by it.

"Because nobody wanted to work, it would take an hour to turn over the surgical room. In my private practice now, it takes ten minutes.

"And I saw tremendous waste: closets of stuff that never got used. Nobody cared.

"Capitalism has completely transformed my sub-specialty. When I was in training, a common procedure that I do now took 40 minutes, and people needed a month of recovery. Now it takes 10 minutes, and people can go back to work almost immediately.

"And all these improvements were driven by the financial incentive. Capitalism has had a tremendously positive effect on patient care and outcome in my specialty.

"But when I go to meetings now, I see that there's very little innovation going on. Everything's being impacted by ObamaCare, which, among other things, raises taxes on medical devices.

"You know, doctors are people, and we're being hammered on all sides here. It's the paperwork; it's insurance; it's transitioning to electronic medical records, so the government can get their mitts into your practice. It's lawsuits; it's rising overhead and decreasing compensation; it's stress upon stress upon stress.

"And a lot of doctors are going to say, 'Forget it. I don't want to do this anymore.' Guys that are 5 or 10 years older than me are just going to give up and walk away.

"Why should I be a slave to the government? You know, it used to be that doctors would do charity work at a charity hospital. Nobody wants to do it anymore, because we're too overwhelmed.

"I work 60 to 70 hours a week, so how am I supposed to fight back against this? Most doctors don't have the time to lobby their congressman or go to Washington. If you're a doctor in the trenches, you've got a stressful job; you've got a family. You're seeing the same number of patients and making half the income you used to make. People are litigious these days, so you've got to worry about lawsuits. When are you going to find time to lobby a politician?

"And the American Medical Association threw us all under the bus, even though only 18% of doctors belong to it. These people are ivory-tower academics, and they're liberals. Most of them are in academic medicine; they get a salary with some sort of incentive bonus. They show up to work and go home. They're not in the trenches like me, figuring out how to compete with other doctors and pay for malpractice insurance and how to hire four people I need to implement the electronic medical records and two people I need to deal with insurance.

"And as a doctor, I get it handed to me both ways. My taxes are raised, and my fees are lowered.

"You know, young people today who go to medical school -- I don't know what to tell them. You couldn't pay me to go to medical school today. Some doctors are going to graduate with $500,000 in debt, and how are they going to make a living?

"You're 32 or 33 years old by the time you finish your training; you're married with little kids. You've been an apprentice for 16 years, and now you're faced with socialized medicine. That's the reality on the ground. How are you supposed to manage that?

"Fortunately, I still love what I do. But I don't know what's going to happen. I think we'll wind up with a two-tiered medical system: a private one for the rich who pay cash and a mediocre one for everyone else.

"When my dad was 91, he had a heart attack and ended up with a stent. He had two more good years after that before he died. After Ob*maCare, some government employee is going to decide that he is too old for this and not 'approve' for him to have that procedure.

"It's just a feeling of helplessness. The only organizations that are fighting for doctors are the Association of American Physicians and Surgeons, and Docs4 Patient Care."

After he hung up, I went to the website of Docs4 Patient Care and found this statement from its president, Dr. Hal Scherz:

The Supreme Court disappointed the majority of Americans who have voiced their opposition to Obamacare, by upholding significant portions of this truly abysmal law. Their decision has left Americans now wondering what it is that the Federal Government can't compel them to do. This is perhaps the worst decision in the history of the Supreme Court and emphasizes the importance of making the correct decision for chief executive, who controls who sits on this bench.

If you want to cure the sickness that's killing America, you'll find a powerful remedy in the voting booth in November.

For Blogger Brian that will be Ob*ma.

Personally, I like Ike.

Brian, nice call on the SCOTUS result. Especially given that few others saw it playing out that way.

Were you aware that the Families USA claim (it wasn’t a study…it was an extrapolation of two prior flawed studies) that “26,100 uninsured died prematurely in 2010” has actually been entirely debunked by Richard Kronick who serves in the Obama administration, and was a senior health care policy advisor to President Clinton? The link below is pretty damning… have a read and let us know if you’re open-minded enough to retract that part of your post.


Big Oil

DJ, I'm inclined to believe research based on a consensus report of the National Academy of Sciences Institute of Medicine more than a Forbes piece written by a guy who pontificates for National Review and works in the investment industry. Compare:


Oh, I forgot. You don't believe in science. The National Academy of Sciences supports the science of human-caused global warming, so it must be wrong about people dying prematurely from a lack of health care also. Isn't that how your illogical brain works?

OK. Let's assume it isn't 26,100 people who die each year, but a tenth as many. That's still about how many died in the 9/11 attacks -- EACH FREAKING YEAR! And we are the terrorists. Us (or rather, mainly you and others who oppose universal health care).

Those who sit by and watch as thousands of people die -- you are responsible for those deaths. They're just unseen, while those who died in the 9/11 attacks were visible. But they're just as dead. Uncompassionate conservatives don't care about those deaths. Us compassionate liberals do.

Yes Brian, you have the market cornered on compassion. Those cold-hearted conservatives also don't give a hoot about a polluted environment either. They like it that way for themselves and future generations. Global warming? They say, "Bring it on!". A solution would be a nightmare for them because the Grand Canyon obscured by smog is a dream come true. They also want blacks back in the fields picking cotton where they belong, right?

Even if as many as 26,000 die due to no insurance that's not a bad percentage in a country of 320 million (.00008%). Of course it would be nice if no one died but no matter what system you have there will always be those who fall through the cracks.

tucson, you're wrong. Every other economically advanced country in the world doesn't let people fall through health care cracks. Only the United States does. And in this country it is the Republicans who want the cracks to remain as they are, or even to make them bigger by cutting social programs.

People are dying as a result of this uncompassionate conservatism. That's a fact. If right-wingers don't like this fact, they should change their ways and start caring about people dying unnecessarily.

I don't mean to offend anybody. I just believe that "compassion" is more than a word, a platitude. I'm not a traditional Buddhist, but I do resonate with the notion that feeling the pain of other sentient beings (humans and animals) is natural and laudable.

When our hearts get hardened, both we and those we turn our backs on suffer. Life is tough enough without people making it even tougher. I mostly spend time with other progressives. We talk a lot about the needs of other people and how to make the lives of those less fortunate than ourselves better.

I just can't understand why conservatives/Republicans don't do the same. It's hard for me to believe that so many people can be so uncaring, but if right-wingers act uncompassionate, I have to believe that they are. Children are going to die if Romney gets his way and repeals the Affordable Care Act. Many others also. How can this be applauded by conservatives?

Brian wrote in quotes:

"And in this country it is the Republicans who want the cracks to remain as they are, or even to make them bigger by cutting social programs."

--This is an emotional position you are taking. Republicans don't "want" people falling through the cracks. They just don't see the Affordable Care Act as being a viable solution.

"I do resonate with the notion that feeling the pain of other sentient beings (humans and animals) is natural and laudable."

--So, conservatives and Republicans are heartless? Another irrational exageration. Boehner is known for his public blubbering. It is Ob*ma who is heartless. When is the last time you saw him blubbering?

"When our hearts get hardened, both we and those we turn our backs on suffer."

--It would seem that conservatives and Republicans are so heartless that they would roast the pet dog for dinner if they were having car trouble and couldn't get to the supermarket.

"...but if right-wingers act uncompassionate, I have to believe that they are. Children are going to die..."

--Yes, Romney shold come clean and admit that he doesn't care if children die. "Die you little peon underclass motherfuckers!"

Brian, you're off the deep end here. Get a grip.

Why is there this stark division in perception in this country? Why are we so polarized? Liberals see things from the heart (government spending and entitlements) while conservatives see things from logic (small government with freedom and self-reliance). It is like Mother Teresa vs Star Trek's Spock. What we need is a Captain Kirk to coalesce these divergent mentalities.

tucson, I don't mean to imply that you and others who oppose the Affordable Care Act are purposely or consciously uncompassionate. I'm sure you, and others, believe that you are doing the right thing -- that the free market is a better way of getting necessary health care to people than government intervention.

But... here's Mitch McConnell saying that 30 million uninsured "isn't the issue." That sure sounds pretty damn heartless, since if you have a serious illness, not having money to pay for it is a huge issue for people in need.

Then there's the polling on this subject. Americans are almost evenly divided overall between liking and disliking the Affordable Care Act. Opinions haven't changed over the past few years. Republicans are much more negative than independents and Democrats.

But when people are asked about specifics in the Affordable Care Act, even Republicans like those provisions. So that's what this country needs to do: focus on specifics. And that's my main criticism of the GOP: Republicans haven't said how they'd do away with denial of coverage for preexisting conditions, while assuring that the 30-40 million Americans without insurance are covered.

All we get are platitudes are Romney and others. Yet Romney's prescription in Massachusetts, which was also favored by the GOP up until Obama took office, was the individual mandate. A lengthy New Yorker article made this clear. The individual mandate is a conservative idea -- an alternative to a single payer system. It forces people to be responsible citizens; if they can afford health insurance, they need to buy it, rather than being a "free rider" on the system.

So where are the specific ideas for solving our nation's health care problems? The Democrats came up with them; the Republicans just continue to say "no." Doing nothing when costs are rocketing upward and increasing numbers of people are uninsured isn't an option for compassionate progressives. At least Obama had the guts to do something. The GOP just wants to repeal and not replace the Affordable Care Act. Gutless.

The title to this post is misleading… read what compassionate conservatism is and is not: http://en.wikipedia.org/wiki/Compassionate_conservatism

The Forbes piece speaks for itself, but if you don’t like the messenger go to the Richard Kronick (Obama staffer and Hillarycare advisor) debunker of the IOM report here: http://onlinelibrary.wiley.com/doi/10.1111/j.1475-6773.2009.00973.x/abstract

Regarding “consensus” on the IOM uninsured deaths claim – Kronick’s work even influenced Politifact to shift from “True” to “Half-True” concluding: “But for us, Kronick’s study raises questions about the reliability of the Institute of Medicine’s death estimate. We acknowledge that there is NOT YET a CONSENSUS among the experts. But in re-evaluating Pascrell's claim, we can no longer rate it True. We recognize that the Institute of Medicine is still widely respected, but an ideologically diverse group of experts is giving credence to Kronick's findings. That leaves us with something of a split decision, and so we downgrade our rating to Half True.” http://www.politifact.com/truth-o-meter/statements/2009/aug/20/bill-pascrell/pascrell-says-22000-americans-die-yearly-because-t/

I’ve been a routine blood donor since the age of 18. I routinely spend Saturday morning donating plasma as well. I had my bone marrow typed and placed on the National Bone Marrow Donor Registry in my early 20’s. Years later in another state the registry contacted me saying I was a ‘potential match ‘ and that if I was still willing they needed to take a blood sample to confirm a true match. I was told to act quickly because the patient was near death. I was excited that I could possibly help save this person so I dropped everything to get re-typed immediately, only to be informed a day or two later that I wasn’t a match. It’s an understatement to say I was sorely disappointed and I hope someday my phone will ring again. (It’s never been easier to get typed or to donate: http://marrow.org/Home.aspx).

For obvious ethical reasons, a marrow donor candidate has the option to change their mind and back out right up to the very last moment in the potentially life-saving marrow donation process. How is it then ethical that the very same donor is compelled by law to buy an insurance policy that helps subsidize the transplant recipient’s operation?

Many of us will someday require an organ transplant to survive. Organ donation is woefully inadequate and many die on waiting lists. Shouldn’t we all be compelled by law to be donors? Don’t the very same arguments of fairness, shared sacrifice, and compassion that are used to propel the universal care mandate also argue for a universal organ and tissue donation mandate?

I’m already on the list in the US. In China, every man, woman and child is on the list too.

Big Oil

I listened to the McConnell video and I don't think he meant that 30 million uninsured is not a problem and that he is OK with that. When we hear these things I thnk we hear through the filter of our own prejudices and conditioning. My filter got that he meant 30 million uninsured is not the heart of the problem which is health care costs and that a government that already can't keep solvent the existing health care plan it already has (Medicare) is not likely to be able to manage the colossus of the ACA either.

I agree that republicans have not put forth a plan other than to open up competition by allowing insurance companies to compete across state lines and tort reform. Obviously that is not enough and they need to do better. But too little is better than too much, imo, if that 'too much' is just going to make things worse.

Government insuring 30 million more people is like putting 30 million more people on the Titanic. One thing that gets overlooked that no one wants to admit is that the USA is bankrupt with a national debt of over 16 trillion whose interest payments cannot even be met.

It may seem heartless but when the boat is sinking you have to start throwing stuff overboard in the hope that you can get to shore and patch the leaks or else the ship will go down with everyone on board.

Now that would be really heartless.

I suspect that the Affordable Care Act will ultimately produce insignificant incremental changes in the way people get taken care of in this society.
First of all, "affordable care" is practically an oxymoron. Most people who cannot afford to buy health insurance will simply pay the income tax penalty. They will still be able to get emergency treatment at any hospital with an emergency room.
Just because people with pre-existing conditions will be able to get insurance does not mean that they will receive quicker treatment, or better quality treatment. I can see a whole new shell game of substandard chemotherapeutic chemicals being substituted for more effective ones for super-expensive cancer therapy, although that probably exists to some extent today, by default.
Mandating that insurance companies extend coverage to dependents of policyholders until age 26 is not that big of a burden on the insurance providers. Most people under 26 years of age don't go do doctors that often. Besides, auto insurance covers most medical bills that arise from accidents.

Physicians will have the most dramatic effect upon health care in the future. It would be an enormous incentive to become an MD if the costs of becoming one were borne by some entity other than the individual. But never fear - there will be plenty of third-world students who will get their education in the Cayman Islands or the Philippines to replace the WASP, whose language and accent are actually understandable.
Shucks. Another shibboleth to stand in Reality's stead.

DJ, you have an anti-scientific habit of only looking for studies that support your preconceived opinion. That's why you're a global warming denier: you believe in something, then argue your case based on that belief -- which leads you in a false circle.

Dig deeper. Open your mind. Discover the glory of Google. Read FactCheck.org, which comes to rather different conclusions than PolitiFact's "half true."

And read Ezra Klein, who has put together an excellent overview of the research on dying prematurely due to a lack of health insurance:

Here's an excerpt:
As found by the IOM’s literature reviews, the research evidence is not unanimous. For example, Richard Kronick’s solid study, referenced by McCardle, found no relationship between mortality and health insurance status. However, the main point of Kronick’s study is that some of the earlier research may have overstated the effect of insurance on mortality by omitting important variables.

Kronick’s study had its own problems because, as his paper alludes, he was not able to address a critically important methodological issue—namely, that people in poor health are more likely to seek health insurance, which obscures any positive relationship between health insurance and health status. Studies that adjust for this factor have found a statistically and quantitatively significant relationship between lack of insurance and increased mortality risk.

After conducting thorough reviews of the research, IOM in 2002 and 2009, McWilliams in 2009, and Hadley in 2003 all concluded that the clear preponderance of findings from well-designed studies strongly link insurance coverage and mortality rates. McCardle erred by presenting the Kronick study as the gold standard for research on this issue to the exclusion of all studies published since 1994 that go against her argument.

Lastly, do you realize how illogical your argument is? If access to health care via health insurance doesn't make any difference in mortality rates (which implies no difference in morbidity rates, since people generally die for some reason other than "old age"), then why does health insurance exist?

Why do people decide to buy health insurance if it doesn't make any difference to their health status? Also, how is it that right-wingers like to talk about the American health system being the "best in the world," yet simultaneously argue, as you are, that having good access to health care doesn't make any difference in an important measure of health: premature death?

I worked in health planning for quite a few years. For a while I was the lead health planner for the state of Oregon. I spent more years working in the field of applied bioethics and health care resource allocation. So I'm a lot more knowledgeable about health care than most people.

Which causes me to say: good try, but per usual, you're wrong. Have more faith in logic, reason, and science. Don't trust your preconceptions so much, and you'll come closer to truth. Which includes: people who have good access to modern health care are, by and large, healthier than people who don't.

Blogger Brian queried rhetorically:

"Why do people decide to buy health insurance if it doesn't make any difference to their health status?"

--Because they don't want to be bankrupted by an expensive illness.

Still, the majority are going to find a way to get treatment even if they have no insurance. True, a few won't.

Brian asks: “Lastly, do you realize how illogical your argument is?”

Brian, unlike most parts of government, the market-driven culture of private industry trains one to confront the obvious… to question conventional wisdom… to break what’s not broken. Competition drives innovation and cost cutting which makes counter-intuitive thinking imperative. Companies like Apple thrive on counter-intuitive thinking. Other companies cease to exist without it. Think Kodak, inventor of digital photography.

What you see as an “illogical argument” on my part is actually counter-intuitive thinking. So to answer your question, YES, I do realize how counter-intuitive my argument is.

Counter-intuitive thinking that questions the observationally obvious is the hallmark of every day scientific discovery and innovation. Galileo understood this and the scientific standard of the double-blind study protects it.

Counter-intuitive thinking comprehends correlation vs. causation. Many of your arguments, Brian, do not. A good example is your rhetorical question, “If access to health care via health insurance doesn't make any difference in mortality rates…then why does health insurance exist?” The rhetorical answer is of course: Health insurance exists BECAUSE it makes a difference in mortality rates. It’s an answer that implies but lacks causation.

Let’s take a counter-intuitive thinking example out of today’s news. Most including myself and surely Brian would agree that pet ownership has both physical and psychological benefits, and these benefits take on added significance for seniors. This is common knowledge and sound conventional wisdom. It would therefore make no sense to research a potential link between suicides in elderly women and cat ownership, right? WRONG. http://www.cbsnews.com/8301-504763_162-57465725-10391704/women-with-cats-may-have-higher-suicide-risk-due-to-feline-fecal-parasite/

So, Brian, did questioning the Families USA report lead us “in a false circle” as you assert? Quite to the contrary, it improved the informational content of this post for readers. Without my critique you would still be referencing the older more inferior Families USA report rather than the more current report from Harvard. That’s not to say the Harvard report doesn’t raise eyebrows as well, but I won’t rat-hole that here.

By the way – since you worked in healthcare resource allocation and bioethics there are a couple of areas it would be interesting to get your expert view on:

1) So-called “rationing” which is touched on in one of tucson’s comments (doctor’s anecdote about a 91 year old no longer eligible for a stent).

2) My contrast between the ethics of voluntary tissue/organ donation vs. the ethics of mandated financial support for the donation procedure itself.

Big Oil

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