Doctor Shortages

John Rossomando describes, "ObamaCare's Most Frightening Consequence: Not Enough Doctors".

In addition to financial pressures caused by decreased reimbursements, the article cites other factors:

Georgia GOP Rep. Tom Price, a fellow physician in the House Republican caucus, warns regulations will also cause doctors to change their minds about staying in medicine because they will make doctor-patient interactions more difficult.

"There will be limitations on medications that will be available, and shortages of medications through the FDA," Price said. "Surgeries will have to postponed because of a lack of medications needed to put patients to sleep, damaging the quality of the care that is received."

Price complains the regulations even come between patients and doctors when it comes to things as routine as how a doctor has to fill out paperwork to order oxygen tanks for patients who need them.

A November 2010 Physicians Foundation Survey underscored this when it found that 56% of doctors it surveyed anticipate the health care law will diminish the quality of care they can give their patients. A further 40% of physicians said they planned to retire, seek a nonclinical job in the health care field or leave the medical profession altogether.

A Galen Institute Study also found that ObamaCare's regulations likely would force countless aspiring doctors to forgo entering the profession at a time when demand for care is on the rise.

"PPACA [ObamaCare] will strip away physician autonomy, drown doctors in bureaucracy and drain job satisfaction," Dr. Jason Fodeman wrote in an April 2011 study for the Galen Institute. "As the profession deteriorates, older doctors will retire while younger doctors will look to switch careers.

"Many students considering a career in medicine will pursue other opportunities."

(Read the full text of "ObamaCare's Most Frightening Consequence: Not Enough Doctors".)

At the anecdotal level, I know doctors who are already planning exit strategies to leave medicine if/when the regulatory environment becomes too unbearable. This will make things harder on the good doctors who still try to stick it out and remain in practice. If enough good doctors decide to quit, it could lead to a "death spiral" for quality health care in America. And most Americans won't want to be treated by the other kind of doctor...

Should SCOTUS Hear The Thomas More Case?

In the 7/30/2011 Washington Examiner, Ken Klukowski of Liberty University argues that anti-ObamaCare activists should not want the US Supreme Court to hear the lawsuit by Thomas More Law Center challenging the individual mandate because it fails to properly address the severability issue.

Here's an excerpt from "Supreme Court should not take this Obamacare case":

The Thomas More Law Center filed one of the Obamacare cases, raising the sole issue of whether the individual mandate is unconstitutional. The case lost in the district court and again before the 6th Circuit federal appeals court. This week the TMLC petitioned the Supreme Court to take the case.

All the major lawsuits challenging Obamacare rightly argue that the individual mandate is unconstitutional. But the brass ring -- the ultimate prize -- is for the Supreme Court not only to strike down the mandate, but to also hold it non-severable from PPACA's other 2,700 pages.

Severability doctrine is how a court determines how much of a law to nullify. It's very rare for a court to strike down any part of a statute aside from the unconstitutional provision...

That's why the three most important lawsuits against Obamacare all raise severability. It's also why the federal judge in the biggest lawsuit (the multistate case from Florida) struck down the entire statute.

Striking down the individual mandate would be a great victory. Such a Supreme Court decision would delineate boundaries on federal power under the Constitution's Commerce Clause and the Necessary and Proper Clause.

The implications would be profound. It would be a shot of adrenaline for the cases challenging the Environmental Protection Agency's cap-and-trade rules, National Labor Relations Board's authoritarian rampage, the Federal Communications Commission's Internet power grab, among other lawsuits.

But, while TMLC's challenge is laudable, a lawsuit attacking Section 1501 but not raising severability doesn't go far enough. If only the individual mandate is struck down, it would immunize 99 percent of Obamacare from further legal challenges.

(Read the full text of "Supreme Court should not take this Obamacare case".)

If Klukowski is right, we should hope that the Supreme Court hears a case that maximizes the chance of striking down the entire ObamaCare law. (In theory, the SCOTUS could also choose to wait until other ObamaCare lower court cases reach them as well, then decide multiple issues at once.)

(Thanks to @Lucidicus for the pointer.)

Save Money On The OTHER Guy!

"Dr. Grumpy" points out how "People accuse doctors of not doing enough, or doing too much".

Basically, it's the medical equivalent of NIMBY (not in my backyard) -- i.e., save money on the other patient, but not me!

Minton: The Coming War on Vitamins

Michelle Minton of CEI (Competitive Enterprise Institute) has a new OpEd in the 7/28/2011 Washington Times, "The coming war on vitamins".

Minton describes the latest proposal by Senator Durbin (D-IL) which, in conjunction with other FDA regulations, would seriously hinder the ability of ordinary Americans to freely purchase many over-the-counter vitamins and dietary supplements. Many of these dietary supplements would have to go an onerous FDA approval process which would either drastically raise their prices or drive them off the store shelves completely.

I'm personally seeing more medically-savvy Baby Boomer patients taking ownership of their health and using these inexpensive supplements to protect against arthritis, digestive problems, etc. Hence, the Durbin proposal would significantly impair ordinary Americans' ability to act on their own best judgment for their best medical interests.

(Read the full text of "The coming war on vitamins".)

NewsMax has a related article drawing on Minton's analysis at, "Now Government Trying to Ban Sale of Your Supplements".

Americans need more health freedom, not more nanny-state regulations!

Government Response to Medical Student Debt?

Glenn Reynolds (aka "Instapundit") has linked to this 7/28/2011 New York Times piece, "The Hidden Costs of Medical Student Debt".

NYT writer Dr. Pauline Chen correctly notes that this may drive medical students away from lower-paying primary care careers and into higher-paying specialties. One likely response from the government already hearing too many complaints from their constituents about a shortage of primary care doctors may be to step up programs such as the "Public Service Loan Forgiveness" for new medical graduates willing to work as primary care doctors in "underserved areas".

Now I have no problem with small rural communities making private deals with aspiring doctors to help pay for their education in exchange for a promise to work there for a certain number of years (i.e., a fully voluntary version of "Northern Exposure").

But if government policies artificially raise student indebtedness, then the government later lets them off the debt hook in exchange for the government telling them where to practice (according to the latest government guidelines of course), that's different.

Then it seems a little too much like a Mafia boss telling the storekeeper that his debt to the local loanshark will be forgiven if he'll let the Mafia decide what products he can (and cannot) sell in his neighborhood store and at what prices.

UK Waiting Lists

The 7/29/2011 Telegraph reports, "Patients struggle even to get on NHS waiting lists".

Here's the opening:

One woman waiting four months for a knee operation was told by a hospital that her name would drop off the list unless she replied to a letter, while a man had to pay £11,000 for a replacement hip after his doctors repeatedly refused to refer him for treatment. A multiple sclerosis sufferer claimed he had had to wait 18 months just to be added to a waiting list.

The examples emerged after The Daily Telegraph disclosed how health service funding bodies are artificially increasing waiting times as they wait for patients to die or go private.

(Read the full text of "Patients struggle even to get on NHS waiting lists".)

Because of the problems of socialized medicine, the UK health providers are increasingly trying to "game" the system to make their statistics look better -- but at their patients' expense. Let's hope this doesn't start happening here in the US.

(Via Dr. Evan M.)

Our Friend the FDA

The FDA says walnuts are drugs.

Also, "The Food and Drug Administration has banned the only over-the-counter asthma inhaler, Primatene Mist, on the grounds that it releases chlorofluorocarbons (CFCs) and is thus bad for the ozone layer."

Fortunately, some people are speaking out against the nanny state mindset. For instance, Scientific American recently urged the FDA and our politicians to "End the War on Salt".

UK Rationing Update

The UK's National Health Service has announced explicit rationing of "hip replacements, cataract surgery and tonsil removal" procedures.

Lucidicus Parodies Romney

The Lucidicus Project has posted a nice video reply to Mitt Romney's campaign commericial.

Here's the Lucidicus version:



I like it much better than Romney's original.



(Learn more about the Lucidicus Project. Here's how to donate.)

Quick Links: Wolf, Simberg

Two recent OpEds not directly related to health care, but worth reading:

Dr. Milton Wolf, 7/26/2011 Washington Times, "GOP's unfounded Obama fears".

Rand Simberg, 7/27/2011 PajamasMedia, "Lies, Damned Lies, and Revenue Enhancements".

Why Should Doctors Trust the Government?

In the 7/26/2011 TownHall column, Dr. Mike Koriwchak asks, "Why Should Doctors Trust the Government?"

An excerpt:

it is despicable for a government representative to contact a physician’s office to gather information under false pretenses. This is a sting operation designed to entrap decent, hard working medical office staff into saying things that could be recorded, taken out of context, refined into sound bites, and used to slander physicians. President Obama has already accused physicians of performing tonsillectomies just for the money. He has also stated that surgeons earn $50,000 for an amputation, which is grossly inaccurate. It is not far-fetched to suggest that the true purpose of this "study" was to gather doctor-bashing material to support Obamacare in the 2012 campaign. Their promise not to identify the responses of individual physician practices is of little comfort- in fact this would make it easier for them to "exaggerate" what was said to suit their purpose. It is incredible that Obama thinks nothing of spying on American citizens.

This "study" would have negative effects on health care. Office staff would no longer be able to trust the person on the other end of the phone. Doctors would have to pay an army of consultants to train office staff how to verify a caller’s identity before having any further conversation. Can you imagine the consequences to customer service and quality of care?

Just making the suggestion of this study serves the government’s true purpose- to intimidate physicians into behaving the way the government wants. This is not the first time. The WH has tried to intimidate us into reporting critics of Obamacare (remember "fishy" comments?). The government has bullied doctors for years with threatened pay cuts, an ever-increasing regulatory burden, and audits using outside contractors who are paid by the amount of fines they extract from their victims ("bounty hunters"), with no accountability regarding the accuracy of their audits.

(Read the full text of "Why Should Doctors Trust the Government?")

The government wants doctors docile and obedient to its edicts. Yet it also wants them to exercise their independent unwavering judgment in the practice of medicine. This contradiction is unbridgable.

(Via D4PC.)

Quick Links: Government Growth, Morality, AARP

At the AEI blog, Christopher Conover writes, "Health Is the Health of the State".

His take-home point, "Between 1966 and 2007, the entire increase in the size of government relative to the economy resulted from growth in tax-financed health spending."

At the NCPA blog, John Goodman discusses, "Is There a Moral Case for ObamaCare?"

Short answer, "No".

Is the AARP lobbying to protect its insurance business bottom line in the debt ceiling debate?

(Links via Dr. Kathleen Brown and Dr. Beth Haynes.)

Manhattan Institute: The Limits of Comparative Effectiveness Research

President Obama has touted "comparative effectivness research" (CER) as a way to save money under his health care plan. In his words:

If there's broad agreement [that] the blue pill works better than the red pill, ...and it turns out the blue pills are half as expensive as the red pill, then we want to make sure that doctors and patients have that information available to them.

Although this sounds good at first glance, there are serious problems using this approach in a one-size-fits-all government health system.

Philipson and Sun of the Manhattan Institute discuss this topic in depth in their latest article, "Blue Pill or Red Pill: The Limits of Comparative Effectiveness Research".

In particular, they note that this approach can cause tremendous problems when policy-makers then treat patients as some sort of global "average" while neglecting their individual differences:

..[I]t is the drug or treatment with the larger average effect on an entire population that "wins." In the president's hypothetical, the blue pills are "just as effective" as the red ones because, on average, they do as much good for patients. But the average patient is not the same as any particular individual patient. Declaring a treatment most effective based on an average is a medical and an economic error, for two reasons.

First, individuals differ from one another and from population averages. Therefore, what may be on average a "winning" therapy may simply not work for a large number of patients. Conversely, a drug that is less effective on average may still be the best, or only, choice for a sizable proportion of patients.

The second reason is the variance in dependence in patient responses across therapies. Dependence, for any individual patient, is the degree to which response to one treatment predicts response to another. Dependence varies from illness to illness and from drug to drug but is often an important aspect of finding treatments that work. One cannot know in advance, as a general rule, that Drug A's failure guarantees the failure of Drug B. Yet a reimbursement policy based on CER could well make this error: by refusing to reimburse Drug B on the grounds that Drug A is "more effective," such a policy assumes that failure with Drug A will predict failure with Drug B.

The bulk of their paper discusses how this CER methodology would fail if applied to real-world antipsychotic drugs, where there are seeming equivalents of Obama's "red pill" and "blue pill".

Because of the factors mentioned above, a policy based on CER that restricted doctors' ability to prescribe (and patients' ability to receive) drugs deemed by the government as insufficiently "cost effective" would actually cost more money in the long run, as well as inflict tremendous and unnecessary hardship on patients.

Of course, CER data can be valuable to practicing physicians who treat patients as individuals. But it can be a dangerous tool when fallaciously misused by policy-makers who treat patients as a collective or an "average".

(Read the full text of "Blue Pill or Red Pill: The Limits of Comparative Effectiveness Research" or download the PDF version.)

Did ObamaCare Torpedo the Economy?

According to the Heritage Foundation, it did.

Here's a graph from their analysis, "Recovery Stalled After Obamacare Passed":

(Via David Catron.)

ACO Humor

Jaan Sidorov of Disease Management Care Blog passes on some ACO jokes. Here are a few samples:

Q: What's the difference between an ACO and a HMO?
A: An ACO is just like a HMO but with more government oversight. It will have the discipline of the Securities and Exchange Commission mixed with IRS-style responsiveness, all brought to you courtesy of CMS.

Q: What's the nicest thing a VP for Medical Affairs could spin about ACOs to a room full of skeptical doctors?
A: "It's not entirely without merit, but close."

Q: What is the difference between an ACO and quicksand?
A: People don't go into quicksand on purpose.

Q: Why is it called an "ACO?"
A: To honor the folks who thought of it: academics, consultants and Obama.

Quick Links: CO-OPS, ACO Lepers, VT

Jared Rhoads of the Lucidicus Project notes, "Government-backed CO-OPs stunt innovation".

(As he noted on Twitter, "If HHS sets the rules, then shouldn't these be called 'HHS-Controlled Health Plans?'")

Dr. Stewart Segal describes how ACO rules will encourage providers to dump expensive patients at "ACOs and the modern day leper".

In the 7/17/2011 Washington Examiner, Sally Pipes observes "It's déja vu all over again in Vermont".

Claeys on ObamaCare, Constitutionality, and Politics

George Mason University law professor Eric R. Claeys has a nice detailed article on the constitutional issues related to ObamaCare and their political implications.

His article appears in the Summer 2011 issue of National Affairs and is entitled, "Obamacare and the Limits of Judicial Conservatism".

I'm still digesting Claeys' piece, but one of the many interesting points he makes pertains to the conventional wisdom that when the "individual mandate" is eventually decided by the US Supreme Court (SCOTUS), there will be 4 conservative votes against and 4 liberal votes for, with the "swing vote" being Justice Kennedy.

Claeys warns:

[T]his conventional wisdom is wrong -- and adhering to it could prove highly counterproductive for Obamacare's opponents. It is wrong largely because it assumes that the Roberts Court's 'judicial conservatives' are members of a monolithic bloc.

In the final section of the paper, he also discusses 4 principles that ObamaCare opponents should keep in mind as the SCOTUS decision draws here:

1. There should be no irrational exuberance about the Virginia and Florida decisions.

2. Obamacare opponents should not despair if the Supreme Court votes not to declare the individual mandate unconstitutional.

3. Opponents of Obamacare must anticipate what to say if the Supreme Court votes not to declare the individual mandate unconstitutional.

4. If legislators and candidates will need to argue against Obamacare's constitutionality later, they might as well start now. And they should consult the opinions of Justice Thomas.

(He discusses each of these points in greater depth in the paper.)

As I mentioned above, I'm still digesting this piece. But it's a thought-provoking read. The full text is available at "Obamacare and the Limits of Judicial Conservatism".

Disclaimer: Professor Claeys was on my wife's PhD dissertation committee.

(Link via GMU law professor Adam Mossoff.)

BHI: The High Price of the Massachusetts Plan

Beacon Hill Institute analysts David Tuerck, Paul Bachman and Michael Head have published a new paper, "The High Price of Massachusetts Health Care Reform".

According to this summary at NCPA:

In this study, researchers calculated the effect of health care reform on state and federal governments and the private health insurance markets, including employee contributions to their private insurance plans:

State health care expenditures have risen by $414 million over the period.
Private health insurance costs have risen by $4.311 billion over the period.
The federal government has spent an additional $2.418 billion on Medicaid for Massachusetts.
Over this period, Medicare expenditures increased by $1.426 billion.
This amounts to a total cumulative cost of $8.569 billion over the period.

The state has been able to shift the majority of the costs to the federal government.

This is clearly an unsustainable approach. The end-stage will have to be European-style rationing of health care. Let's hope the rest of America learns from the example of Massachusetts -- before it's too late...

Update: Investor's Business Daily also summarizes the BHI findings in their OpEd, "Massachusetts Mess".

Wolf: Barack Obama’s Pants On Fire

Dr. Milton Wolf's latest OpEd for the 7/19/2011 Washington Times details the President's disturbing habit of stretching, bending, and tearing up the truth when politically convenient.

From "Barack Obama's pants on fire":

"I will never forget watching my own mother... worrying about whether her insurer would claim her illness was a pre-existing condition," claimed Democratic presidential candidate Barack Obama, explaining the foundation of Obamacare. This too was a lie.

Recent revelations by author Janny Scott in "A Singular Woman: The Untold Story of Barack Obama's Mother" (Riverhead Hardcover, 2011), show that Stanley Ann Dunham, the president's mother, was in fact well-insured and, what's more, her health insurance company -- those evil corporatists -- never attempted to deny payment for her health care...

Dishonoring the dead with deception, as pathetic as that is, barely scratches the surface of the Obamacare falsehoods. You can keep your current doctor: Lie. You can keep your current insurance: Lie. Hearings will be made public: Lie. The deficit will be reduced: Lie. Four hundred thousand jobs will be created immediately: Lie. There are no death panels: Lie. Taxes won't be increased on families earning less than $250,000 a year: Lie. And all of this comes before the first Obamacare waivers exempted the White House's best friends from the rules that you must follow.

This degree of dishonesty is not merely taking a mulligan on the back nine or fudging a couple of pounds on your driver's license. There's something far more sinister at work here. America is being "fundamentally transformed" by deception...

Even worse, the problems go far beyond health care policy. For more information, read the full text of "Barack Obama's pants on fire".

Then decide if the country can survive 4 more years of the current political leadership.

Scherz: Has the American Medical Association Lost Its Way?

Dr. Hal Scherz has a new OpEd in the 7/18/2011 Fox News, "After Supporting ObamaCare, Has the American Medical Association Lost Its Way?"

The short answer is, unfortunately, "yes".

In his piece, Dr. Scherz covers some facts not well-known to many in the general public, including:

(1) The AMA does not speak for anything close to a majority of physicians. Rather, less than 17% of practicing physicians are AMA members.

(2) The AMA's source of revenues (including their government-granted monopoly on medical coding) creates a deep conflict-of-interest when the support government policies such as ObamaCare.

(3) The current CEO of the AMA has close links to the Obama administration.

These are some reasons that many doctors like myself refuse to join the AMA.

Instead, I hope doctors and patients take a closer look at other medical organizations like Docs4PatientCare.org that can speak out for genuine health care reforms.