The blog of Freedom and Individual Rights in Medicine (FIRM)
U.K. doctors will stage a partial strike on June 21, the first such step since the mid-1970s, after voting for action to resist proposed changes to their pensions, the British Medical Association said.Perhaps these ungrateful UK physicians didn't get the memo from Stanford health economist Victor Fuchs declaring that "freeing" doctors from the burdens of private practice and turning them into government employees would be like "the emancipation of slaves".
If healthcare were truly a right, members of the medical field would by default be rendered the servants of those who have the “need” to obtain, but not the expertise to create, health insurance. In the event that there were not enough insurance providers, somebody somewhere would have to be forced to enter the medical field in order to be able to satisfy the right of his fellow citizens to a service which requires effort on somebody’s part. Failure on the part of the mystically inexhaustible supply of health insurance providers would thereby constitute a violation of the rights of all uninsured people.And given the combination of the impending shortage of physicians as well as the dangerous notion of a "right" to health care, the next step may be some form of government-compelled "mandatory service" of physicians.
This is just the latest attempt by the USPSTF to limit effective screening methods for cancer. In 2010, they made recommendations to significantly curtail screening mammography for breast cancer in women. Now they are recommendations, but soon, when Obamacare is fully implemented, these will be policy, not suggestions, and will have the full force of law behind it. Other screening programs will soon be on the chopping block, like colonoscopy for colon cancer screening.
The reason behind this is simple. It is about money, power and control. On the UTPSTF web site, it states that over 1000 PSA tests were necessary to save a single life from prostate cancer.
Someone in Washington has decided what the value of a human life is, and what would be the acceptable cost associated with saving it. This is called “comparative effectiveness” and is what happens in a socialized healthcare system, like in England, where resources need to be allocated prudently, and healthcare is rationed. This is the essence of Obamacare -- a system where medical decisions have been taken away from patients and their doctors and transferred to bureaucrats in Washington.Dr. Scherz also notes that President Obama had this PSA test within the past year. So his doctors considered it appropriate. But Obama's panel of experts don't want you to have the same level of medical care.
The Affordable Care Act (ACA) ends local-regional physician and patient control of medical decision making by shifting them to bureaucrats in Washington while fundamentally changing healthcare delivery models and reimbursement. Hospitals are the major beneficiaries of these changes- a requirement necessary for the American Hospital Association to support this law.
The law stipulates that physicians can no longer own hospitals. It also creates a new payment model for medical services which favors hospitals. The Accountable Care Organization (ACO), is an integrated healthcare delivery model devised to control costs by issuing a single payment for an episode of care for a patient. The ACO then divides the payment "fairly" among those involved in this episode. This payment model was unsuccessful in recent trials, but was so well supported by non-clinical health care planners who had the ear of the administration, that it was included in the law. Hospitals will typically be in charge of these ACO arrangements, because they already have the infrastructure required by the government for implementation.
In anticipation of this sea change, hospitals are engaged in a "feeding frenzy", buying up predominantly primary care practices, but specialty practices too. In many cities, hospitals compete for these practices, vying for control of as many patients as possible in a community. Once achieving "critical mass", with enough primary care practices, hospitals can approach a specialty group with a Mafia style "offer that they can't refuse". They make it clear to the specialty practice that the doctors who previously sent them patients are now controlled by them. They can either take the hospital’s offer for their practice or go out of business.
The end of private practice is imminent in an ACO world. Small practices will be unable to survive. What is not advertised is that in such a system, doctors become employees. Their allegiance is no longer to their patients, but to their boss, who is interested not in treating infections, or replacing hips, but in balance sheets, and return on investment.(Read the full text of "There Will Never Be Another Mayo Clinic". )
On Monday, 43 high-profile Catholic organizations, including the Archdiocese of Washington, D.C. and the University of Notre Dame, filed suit against the Obama administration. In an open letter, the Archbishop of Washington summed up the collective position of the plaintiffs by explaining that the mandate "fundamentally redefines the nation's long-standing definition of religious ministry… HHS's conception of what constitutes the practice of religion is so narrow that even Mother Teresa would not have qualified."As before, they are (properly) objecting to government mandates requiring them to provide contraceptive coverage to their employees.
Perhaps the Catholic Church, which often seems to back economic "fairness" rather than market freedom, will be more sensitive to the intrusions of the state in economic choice. This episode exhibits how economic freedom is intricately tied to all other liberties. When the state creates virtual monopolies through regulatory regimes, it also gets to decide what is moral and necessary and compels everyone to act accordingly.The Catholic organizations might not have had to file this recent lawsuit if they had previously taken a principled stance against ObamaCare before it became law.
People have increasing opportunities to participate in genetic testing that can indicate their range of risk for developing a disease. Receiving these results does not appreciably drive up or diminish test recipients' demand for potentially costly follow-up health services, according to a study performed by researchers at the National Institutes of Health and colleagues at other institutions.(Read the full text.)
What simple health care reform has reduced medical costs by up to 30%, while preserving quality of care? Hint: It's not government price controls or mandatory health insurance. Rather, it's letting patients decide how to spend their own health care dollars...(Read the full text of "Just Who Should Control Your Healthcare Spending?")
At a time when it is trendy to invoke the term “war” against various groups, such as the contrived, GOP “war against women” or “war against seniors”, it may appear trite to say that there is a war against doctors; but there is. This has been going on for decades and cannot be blamed on President Obama or the Affordable Care Act (ACA), but sadly, both have facilitated an escalation of this war...2) David Catron, "Obama's Contempt for the Voters" (American Spectator)
The statistics are astounding. According to Forbes’ Suzanne Hoppough, from 1960 to 2007 the percentage of U.S. workers belonging to a licensed profession rose from 4.5 percent to 28 percent. In all, writes Hoppough, occupations requiring a government license in at least one state—including dentists, plumbers, hairdressers, secretaries, librarians, wallpaper hangers, and florists—rose from 80 in 1980 to 1100 by 2008.
The economic cost is incalculable. Licensure restricts the supply of workers in the occupations affected, stifling innovation and entrepreneurship, suppressing competition, and driving up prices. And the violation of American’s rights to liberty and the pursuit of happiness are patent: We are forbidden to act or contract in accordance with our judgment, forbidden to pursue our happiness as we see fit, forbidden to earn a living in these areas unless we have permission, in the form of a license, from the state.The professions being licensed often talk in terms of guaranteeing quality standards, but too often these are just thinly veiled pretexts to reduce competition.
So what’s a president to do when his stimulus has failed and his health care takeover is even worse? Avoid them at all costs. Talk about anything else. Student loans. Birth control. Hooded sweatshirts. Heck, even talk about eating dogs.Anything besides the two issues that define his presidency and threaten our republic.
It's Obamanomics and Obamacare, the intertwined strands of evil DNA, stupid.I don't know whether the GOP and presumptive nominee Mitt Romney will wise up to these tactics.
The provision took effect in 2011, and physicians report that they now are being saddled with the task of writing otherwise unnecessary prescriptions for medications to fight the common cold, flu or allergies.(Via @OHPCenter.)
* Moving away from "fee for service" towards a system of "bundled payments", where hospitals and doctors receive a fixed fee for caring for a patient's medical problems
* Overt price controls, where the government can punish a hospital if it charges more than what the state considers "reasonable"
* A global cap on state medical spending, linked to the Gross State Product (state equivalent of GDP)The "bundled payments" in particular will produce perverse incentives for doctors and hospitals.
By reiterating the preposterous claim that Medicare payments might be delayed if Obamacare is struck down, Berwick is participating in a predictable election year strategy that goes beyond meddling with the Court. The threat is also meant to frighten seniors.
Like the perennial Democrat claim that the GOP is secretly planning to destroy Social Security, this strategy seeks to exploit the insecurities of the elderly. Obama and his creatures want the nation's seniors to be so afraid of losing their retirement benefits and medical coverage that they will go to the polls and vote Democrat notwithstanding the President's pathetic record and the failure of his party's congressional leaders to produce a single piece of useful legislation since they returned to power in 2007.But as Catron notes, "Ironically, it is the prospect that the Court might preserve Obamacare that should frighten seniors."
Starting next year, New York will become the first state to require lawyers to perform unpaid work before being licensed to practice, the state’s chief judge announced on Tuesday, describing the rule as a way to help the growing number of people who cannot afford legal services.
The approximately 10,000 lawyers who apply to the New York State Bar each year will have to demonstrate that they have performed 50 hours of pro bono work to be admitted, Chief Judge Jonathan Lippman said. He said the move was intended to provide about a half-million hours of badly needed legal services to those with urgent problems, like foreclosure and domestic violence.The Freakonomics Blog asks a very natural question: "What would happen if newly minted doctors were similarly seconded into pro-bono work?"
But young doctors face the same squeeze as young lawyers. Like law school, medical school is so competitive that today’s students need advanced training and graduate degrees in order to get in. By the time they qualify as doctors, they’re well into their 30s, with $180,000 in debt.
And the expectations of medical students are also disconnected from reality. The trouble is that doctors have just one big client – government – whose ability and willingness to pay is shrinking fast. The booming consumer demand for medicine doesn’t necessarily translate into jobs. Even though hospitals need extra surgeons, they aren’t hiring them because they can’t afford to expand operating-room time.
Of all the general surgeons who finished medical school at the University of Toronto in the past two years, only 15 per cent have found work. The rest are pursuing further training, in hopes that something will eventually open up.Things aren't quite this bad in the US. But as government directly or indirectly imposes further restrictions on how doctors can practice and what they can get paid, we'll see more bright young people decide not to become physicians.
1) Regulatory oversight that is completely focussed on compliance. "It discourages risk-taking and innovation," Deane said.
2) Health care doesn't have the same financial reward system. Facebook isn't about to pay $1 billion for the latest hot-ticket item in imaging and informatics.
3) And, finally, Deane said, "Security always trumps information sharing, and so better, faster linkages are constrained because of security concerns, most of which are bogus."Curious how that the increased government interference in the health care market reduces the degree of innovation.