Doctor Shortages Worsening

More on the upcoming doctor shortages and some consequences:

NY Daily News: "The doctor will see you...never".

Forbes: "Amid Doctor Shortage, Hospitals Turn To Dwindling Supply Of Nurses, Physician Assistants".

Kaiser Health News: "Group Appointments With Doctors: When Three Isn't A Crowd".

Hsieh Forbes OpEd: Is Concierge Medicine The Correct Choice For You?

Forbes has just published my latest OpEd, "Is Concierge Medicine The Correct Choice For You?"

I discuss the benefits of this practice model for both patients and doctors as well as dispelling some myths.

(Some of this material is drawn from my recent SnowCon 2013 talk, "Concierge Medicine: The Last Bastion of Health Care Freedom").

Denver-area readers might also be interested in this related recent short piece in 5280 Magazine:
"The Doctor Is (Always) In".

Quick Links: Catron, Scherz

David Catron offers his thought on the 3rd birthday of ObamaCare: "Obamacare: The World's Ugliest Toddler".

Dr. Hal Scherz asks a question that perhaps you should also ask: "Is Your Doctor Really A Doctor?"

Mead on Medical Breakthroughs And Smart Policy

Walter Russell Mead has a nice blog post on "Medical Breakthroughs And Smart Policy".

One excerpt:

The world is in the early stages of a golden age of biotech innovation, one that has the potential to revolutionize everything from health care and manufacturing to energy production. And the biotech revolution will build on and add to the infotech revolution that has been shaking the world for the last 50 years. The 21st century will be more different from the 20th than the 20th was from the 19th. And the 22nd century will be something else again, if we don’t kill ourselves en route.

VM never gets tired of pointing this out for one very simple reason: wonks who don’t keep the innovative dynamism of our age at the forefront of their minds as they think up new policies are likely to do more harm than good. Trying to build elaborate models for the future of healthcare based on today’s delivery systems and economic models is as futile as trying to build a national transportation model in 1830 based on the success of the Erie Canal.

I addressed a related issue in a 2010 PJMedia OpEd, "The Deadly Tax on Medical Innovation":

ObamaCare could thus strangle many promising developments in their cradles before they ever reached the marketplace, such as new cancer treatments, handheld diagnostic equipment, nanotechnology, etc.

And the worst aspect is that we will never know what new technologies could have been developed and how many lives they could have saved — an example of Frederic Bastiat’s principle of the seen and the unseen. As with any exponential process, small changes in the rate of growth will have a dramatic effect on the final total after twenty years.

I encourage folks to read the full text of Mead's "Medical Breakthroughs And Smart Policy".  (Via Instapundit.)

Wolf: Happy Birthday, Obamacare

Dr. Milton Wolf has a new OpEd in the 3/22/2013 Washington Times, "Happy birthday, Obamacare".

He discusses some of the initial lies and false promises used to sell the health law to the public 3 years (and the subsequent reality), including:

“[N]o matter how we reform health care, we will keep this promise: If you like your doctor, you will be able to keep your doctor. Period.”

“If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what.”

Obamacare will “cut the cost of a typical family’s premium by up to $2,500 a year.”

Dr. Wolf is not celebrating the 3-year birthday of the law.  Nor am I.

(For details, read the full text of "Happy birthday, Obamacare".)

Related story from Investor's Business Daily: "ObamaCare Turns Three: 10 Disturbing Facts Americans Have Learned".

Update: Link was broken, now fixed!

Adalja On Medical Marijuana

Dr. Amesh Adalja has a new OpEd, "Medical Marijuana Opposition Is Support Of Socialized Medicine" (Forbes, 3/20/2013).

One nice passage:

Laws against physicians prescribing marijuana—in the remaining 30 states that have not legalized it for medicinal (or recreational) use and by the federal government—are tantamount to the government dictating how medicine should be practiced, shoving its force-wielding hand in between a patient and physician.

What is paradoxical is that the same individuals who forcefully—and quite rightly—oppose the presence of the government in the healthcare realm in the form of the individual insurance mandate, bureaucratic requirements, restrictions on health care savings accounts (HSAs), pre-existing condition rules and the like, often are the most vociferous opponents of allowing marijuana to be used medicinally.

In reality, there is no difference between the government forcing its way into an operating room determining what operation a specific condition requires, and forcing its way into a doctor’s office to prohibit the prescription of a substance that a physician, after weighing the evidence in the context of a patient’s symptomatology, deems appropriate.

 (Read the full text of "Medical Marijuana Opposition Is Support Of Socialized Medicine".)

Quick Links: Catron, Scherz, Preston

David Catron: "Obama Shafts Poor and Minority Seniors Again" (American Specatator, 3/18/2013).

He notes that, the "[l]atest cuts in Medicare Advantage hits those who can least afford it."

Dr. Hal Scherz: "Why Pay Physicians Anything At All For Providing Healthcare?" (Townhall, 3/18/2013).

(As Dr. Megan Edison astutely observed, "Why all this attention to 'doctor pay' when it is only 8.6% of healthcare costs? Because controlling doctors by changing their compensation structure is how to control 1/5 of the American economy.")

Bryan Preston: "Thanks to ObamaCare, You May Soon Get Serious Medical Treatment from People Who Lack Medical Training" (PJMedia, 3/7/2013)

Hospitals Buying Doctors

In the 3/15/2013 Forbes, Scott Gottleib explains that, "Hospitals Are Going On A Doctor Buying Binge, And It Is Likely To End Badly".

One point:

The doctors will get squeezed but the real misfortunate will befall patients. We will increasingly be getting our medical care out of busy, hospital-run clinics. Our doctors will be salaried employees, more beholden to the rules that hospitals erect to manage their activities than the medical practices that they once owned.

He also has a related Wall Street Journal piece, "The Doctor Won't See You Now. He's Clocked Out".

In this piece, he observes:

Big government likes big providers. That's why ObamaCare is gradually making the local doctor-owned medical practice a relic. In the not too distant future, most physicians will be hourly wage earners, likely employed by a hospital chain.

Why? Because when doctors practice in small offices, it is hard for Washington to regulate what they do. There are too many of them, and the government is too remote. It is far easier for federal agencies to regulate physicians if they work for big hospitals. So ObamaCare shifts money to favor the delivery of outpatient care through hospital-owned networks.

Note that the patient becomes the least important party in this new system.

McArdle on Antibiotic Resistant Bugs

Megan McArdle warns, "Worried About Incurable Tuberculosis? Stand By for Incurable Everything".

Read the whole thing.

Also, Diana covered this topic in her 2/17/2013 podcast segment on, "Antibiotic Resistance in a Free Society".

Doctor Training Crunch

The Wall Street Journal reports, "More Medical Students Are In the Pipeline, but Too Few Residencies Await Them":

U.S. medical schools are expanding to meet an expected need for more doctors due to the federal health law. With at least 12 new schools opening and existing ones growing, enrollment is on track to produce 5,000 more graduates a year by 2019.

But medical educators are cautioning that those efforts won't do anything to alleviate a doctor shortage unless the number of medical residency positions rises as well. The number of federally funded residencies has been frozen since 1997...

 In other words, don't expect the doctor shortage to be alleviated in the near future.  (Via Dr. Richard Amerling.)

The Benefit of Direct Pay Models

Some of these "direct pay" models could be of enormous benefit to patients and doctors, while preserving health care freedom.

One important take-home point is that "direct pay" (sometimes known as "concierge medicine") isn't just for the wealthy.  Rather, there are many options evolving in the marketplace suitable for middle-class and poorer patients.

BTW, I'll be talking about this topic in greater depth in my lecture tomorrow for SnowCon 2013 entitled, "Concierge Medicine: The Last Bastion of Health Care Freedom".

Here's the abstract of the talk:

As the ObamaCare health law is phased in, patients will be increasingly subjected to government controls dictating what care they can receive and when. Fortunately, many doctors are responding by moving into various type of "concierge medicine" and "direct pay" practices where they can still treat patients according to their own best judgment relatively free from such government constraints.

This talk will discuss the rapidly growing field of concierge medicine, the various concierge models, why many patients can benefit from it, how to evaluate a concierge practice, and how and why patients can help defend the morality of concierge medicine. 

Scherz: Connecting The Dots

Dr. Hal Scherz of Docs4PatientCare has a new TownHall.com OpEd, "Connecting the Dots on Healthcare".

He makes a couple of important points, including that the current system will fail in a way that will lead to a push for government-run "single payer" care.

He also notes:

Another piece of the puzzle is hospitals. Their powerful lobby made sure that very favorable provisions were included in the ACA, giving them an unfair market advantage. They are consolidating, merging with other hospitals and  purchasing physician practices, leaving some areas of the country short of physicians in private practice. They are creating entities called Accountable Care Organizations -- similar to the capitated HMOs of the 1990s, only much worse. Anti-trust laws are being relaxed or ignored entirely to accelerate this process. The ACO is better suited to deliver government run healthcare because physician behavior is easier to regulate.

(Read the full text of "Connecting the Dots on Healthcare".)

Age-Based Rationing in Sweden?

Reader J.W. alerted me to this story in the Swedish news about apparent age-based considerations in drug subsidies.

Using Google translate, the article is entitled: "Age weighed in medicine bill" (March 10, 2013).

From the translated version:

Niklas Hedberg, head of the new drugs on the TLV, believes that there is an unfortunate wording, but that the work complies with legislation stipulating that they must weigh each consequence of a drug subsidy. 

-For us it is a very complex issue, the starting point is that society's resources for drugs is limited and we are commissioned to be those that prioritize the allocation between different patient groups. Since the legislation has made clear that we must weigh up different principles, and we will take account of drugs in a society holistically, says Niklas Hedberg. 

Would you expect that retirees actually costs if they survive? 

-What is unfortunate is that you can get the picture that it just is a matter of age, it only concerns pensioners. But I think your question is good and it is also very complex. Should we take into account that a patient can start working or not? It is then output effect comes into play.Consumption effect is always when you extend the life of a treat. 

Are pensioners lives worth less? 

-Everyone's health is valued as much, but the calculation model allows perched on top gives the socio-economic perspective, an added benefit of the treatments that allow the patient group can start working again.

In effect, those who are deemed more productive to society will be given higher priority in the national health system than those who are considered a net drain.

This is a nearly-inevitable outcome when medical care (and the system of payments) is considered a collective good that must be allocated accordingly.

The US isn't at this point yet.  But there are intellectuals and policy writers laying the groundwork for similar rationing here.

(One example is this article, "Principles for allocation of scarce medical interventions", co-authored by former Obama administration health policy advisor Zeke Emanuel, brother to former Obama chief of staff Rahm Emanuel.)

Catron: GOP Governors Squander SCOTUS Victory

An unfortunate update from David Catron: "Eight GOP Governors Squander SCOTUS Victory".

He reminds us that the 2012 Supreme Court decision

...dealt the Obama administration an important defeat on one of the two primary issues decided, namely whether the federal government has the right to withhold all matching funds from a state that fails to expand Medicaid according to the dictates of the unpopular health care law.

Medicaid is a joint state-federal program, yet a provision of Obamacare required the withholding of all federal funds from noncompliant states. The plaintiffs argued that this was so coercive that it amounted to an unconstitutional “commandeering” of the states. Seven of the nine justices agreed. This victory, despite the Court’s ruling that the individual mandate is somehow a tax, was viewed by many as an opportunity for GOP governors to thwart implementation of an integral component of the law.

To the disgust of Obamacare’s opponents, however, eight GOP governors have nonetheless decided to comply with the law’s Medicaid provision. Arizona’s Jan Brewer, Florida’s Rick Scott, Michigan’s Rick Snyder, Nevada’s Brian Sandoval, New Jersey’s Chris Christie, New Mexico’s Susana Martinez, North Dakota’s Jack Dalrymple, and Ohio’s John Kasich have all caved. Even worse, several of these people have been vocal opponents of Obamacare and govern states that participated in the lawsuit that produced the Court’s favorable ruling.

 He discusses the fiscal implications, then adds:

What makes this so infuriating is that these Republican governors are waving the white flag after winning a hard fought legal battle in order to escape this very dilemma.

 (For more details, read the full text of "Eight GOP Governors Squander SCOTUS Victory".)

BRS Interview with Dr. G Keith Smith

From Dr. Beth Haynes of the Benjamin Rush Society:

Alex Chamessian of the Duke chapter of the Benjamin Rush Society has set up the opportunity for all of us to watch Dr. Keith Smith, co-founder and managing partner of the Surgery Center of Oklahoma, via live web conference  tomorrow March 7 @ 12 PM EST.

The Surgery Center of Oklahoma is a physician-owned hospital which is changing healthcare in a positive direction. Check out their drastically reduced prices which they post on their website. I hope you can join us for this live presentation.

More information from Alex Chamessian:

Here is a great video introductino to Dr. Smith

http://reason.com/reasontv/2012/11/15/the-obamacare-revolt-oklahoma-doctors-fi

I'd like to invite all the BRS chapters to join us live:

https://www.youtube.com/user/dukebrs?feature=mhee

To participate in the Q&A on Google Hangout, people should sign up here with their Google accounts:

http://www.eventbrite.com/event/5708526356

Best,

Alex Chamessian, MS3

Duke University School of Medicine

Quick Links: Catron, Scherz, Brase

David Catron: "Privatization Shellacs Obamacare Model".

Dr. Hal Scherz: "Healthcare and Politics Do Not Mix".

Twila Brase: "The Obamacare exchanges aren't 'marketplaces'".

Benjamin Rush Society March Debates

The March 2013 debate schedule for the Benjamin Rush Society is now out!

     

  Benjamin Rush Society-Arthur N Rupe Debate Series

March 11 @ Ohio State University “Current Financial Conflict of Interest Policies Create Unjustified Obstacles to Medical Innovation and the Development of Affordable, Quality Medical Care”   Dr. Tom Stossel, MD (Harvard) and Dr. Andrew Thomas, MD (OSU)

March 12 @ Mt.Sinai Medial School, NYC “Medicare and Medicaid must be drastically changed to survive the current budget crisis and health care reform." Sally Pipes (Pacific Research Institute) Dr. Scott Gottlieb, MD (American Enterprise Institute), Dr. Chris Lillis, MD, (Doctors for America), Dr. Elizabeth Rosenthal, MD (Physicians for a National Health Plan)

March 26 @ Yale University   "Markets with Limited Government Intervention are the Best Way to Control Spending Growth in Health Care." Avik Roy, (Forbes, The Apothecary) Joshua Archabault, (Pioneer Institute of Public Policy Research), Dr. Elizabeth Rosenthal, MD (Physicians for a National Health Plan), Dr. William Sage, MD, JD,(Visiting Professor of Law at Yale Law School) 

For more information, see the BRS website.