American Elephants


“Mission Accomplished” says Obama. Now What? by The Elephant's Child

I had a routine doctor’s appointment last week. As she interacted with the new computer system rather than me, my doctor said “I should have gone to secretarial school instead.”

So after “Obama’s ‘Mission Accomplished’ moment—his triumphal Rose Garden speech claiming ObamaCare is now here to stay—where are we? No one believes Obama’s lofty claims for the numbers of enrolled people, and the number who have actually paid their premiums (the only point at which the numbers are real) are numbers that will have to come from the insurance companies.

The underlying signs of the health of this dreadful medical law are something quite different. Kaiser Health News published the following:

Janis Finer, 57, a popular primary care physician in Tulsa, Okla., gave up her busy practice two years ago to care full time for hospitalized patients. The lure? Regular shifts, every other week off and a 10 percent increase in pay.

Lawrence Gassner, a Phoenix internist, was seeing four patients an hour. Then he pared back his practice to those who agreed to pay a premium for unhurried visits and round the clock access to him.  “I always felt rushed,” said the 56-year-old. “I always felt I was cutting my patients off.”

Tim Devitt, a family physician in rural Wisconsin, took calls on nights and weekends, delivered babies and visited his patients in the hospital. The stress took a toll, though: He retired six years ago, at 62.

Physician stress has always been a normal fact of life, but anecdotal stories suggest a significant increase in the level of discontent, especially among primary care doctors who play the central role in coordinating patient care. Just as millions of Americans are obtaining health insurance through ObamaCare because of the threats of fines, or because their insurance policies were cancelled— often because the benefits they chose did not match the government’s one-size-fits-all standard.

A 2012 Urban Institute study of 500 primary-care doctors found that 30 percent of those age 35 to 49 planned to leave their practices within five years. The rate jumped to 52 percent for those over 50. A RAND study for the American Medical Association found that nearly half of physicians called their jobs “extremely stressful” and more than one-quarter said they were “burning out.” Unhappy doctors make for unhappy patients, and unhappy patients result in unhappy doctors.

Janice Finer, who left primary care to work with hospital patients, didn’t want to have to deal with insurers, hiring staff, and the business of a practice —sold her practice to a hospital. But hospital administrators dictated the pace. She was required to see 22 to 28 patients a day. At one point, she said, she was scheduled to see patients every 11 minutes. But meeting patients’ needs is not just busy work, but it doesn’t generate revenue.

President Obama contributed billions to help defray providers’ costs of going digital. The goal was a national system that would provide the government with statistics for further control. Not happening. Every hospital may have a different system, and none of them talk to each other. Digital records mean entering numbers and words in lots of repetitive boxes, but the old kind of personal, nuanced information that was in a doctor’s note, aren’t included. “Many physicians told us “I used to be a doctor, now I’m a clerk.” Anyone who uses a computer can recognize the potential for error. Typos are a way of life. Some doctors have started using ‘scribes’ —laptop carrying assistants who fill in the blanks and take notes— which adds another level of cost.

The association of American Medical Colleges estimates that the U.S. will be short about 45,000 primary care doctors in 2020 when 260,000 are projected to be practicing. Doctors used to encourage their kids to go into medicine. They’re not doing that anymore.

President Obama in his “Mission Accomplished” speech stressed the objective of the Democrats who drummed up this mess: “We are making sure that we are not the only advanced county on earth that doesn’t make sure everybody has basic health care.” Tinkering and improving are expected to lead to single-payer health care which is the their ultimate goal.

Nationalizing health care inevitably leads to conflicting problems.Government programs always cost more than was estimated — way more. The government’s sole incentive quickly becomes a demand to reduce costs.

The incentive for hospitals and clinics is the need to get adequately paid for their services. Those incentives lead to a reduction in innovation unless it is proved to reduce costs— so fewer medical inventions, fewer new drugs.

And pressure on doctors and personnel is to do more in less time with fewer and cheaper materials.  The incentive is also for doctors to leave the profession or for doctors to become government employees. What is inevitable is a lot of burned-out doctors who become more cynical and less caring. Ezekiel Emmanuel, who was one of the advisers for ObamaCare, has advocated disposing of the Hippocratic Oath.

The problem for patients becomes getting an appointment, getting use of expensive diagnostic equipment, and facing long waits for seeing a doctor and seeing a specialist and just getting the needed care. A frequent look at British newspapers’ accounts of the latest NHS scandal is proof of where it all leads.

If health care is free or low-cost at the point of service, the incentive is to overuse medical care which is what got us here in the first place. When someone else is paying the bill, there is no incentive for thrift,  which drives up costs and the vicious cycle repeats and  grows slowly worse, and harder to change.  Incentives matter.

 

 

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1 Comment so far
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Excellent delineation.

Comment by Marc Winger




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