Michael F. Cannon @ Cato:
Today’s New York Times features an opinion piece by J.D. Kleinke of the conservative American Enterprise Institute. Kleinke’s thesis is that ObamaCare’s conservative opponents should stop complaining. “ObamaCare is based on conservative, not liberal, ideas.”
If one defines conservative ideas as those that emphasize free markets and personal responsibility, there is zero truth to this claim.
- Free markets require freedom, like the freedom to control your own property, to enter markets, and to negotiate prices and other contractual terms. ObamaCare mandates how people must dispose of their property, imposes tremendous barriers to entry into markets, and imposes price controls and myriad other terms on ostensibly private contracts.
- Market prices are the lifeblood of a market economy. Kleinke considers them a “flaw” that ObamaCare uses “market principles” to “correct.”
- As I have written elsewhere, ObamaCare “promotes irresponsibility by allowing healthy people to wait until they get sick to buy coverage. It creates that free-rider problem, which has been known to make insurance markets collapse. Supporters of the law could have taken personal responsibility for this instability they introduced into the market—say, by volunteering to pay the free riders’ premiums. Instead, they imposed a mandate, which attempts to stabilize the market by depriving others of their money and freedom. Forcing others to bear the costs of your decisions is the opposite of personal responsibility.”
- Employers are hardly “free to decide” under a law that penalizes them for not offering government-designed health benefits.
- Kleinke is apparently unaware that half of the $2 trillion of new government spending in this “pro-market” law comes from a massive expansion of a tax-financed, government-run health insurance program that crowds out private markets — Medicaid.
I could go on.
Even if one adopts the more forgiving definition that conservative ideas are whatever ideas conservatives advocate, there still isn’t enough truth to sustain Kleinke’s point.
It looks like the majority of doctors hold the same opinion of Obamacaretax as the rest of the population. I guess Larry is in the minority amongst his profession.
http://www.newsmax.com/Newsfront/doctors-survey-support-romney/2012/10/01/id/458316
Hi Another vet: The “survey” was just that: an ONLINE SURVEY (i.e. not a real poll). Real Clear Politics doesn’t, to my knowledge, include online “surveys” in it poll aggregations, nor does Nate Silver’s “538” blog. It wasn’t a true poll with scientific methodology.
ObamaCare is supported by primary care doctors and academic doctors and opposed by private practice specialists. The reason for this is that it seeks to change the imbalance between payments for procedures (performed by surgeons and other specialists) and payment for cognitive services and seeks ultimately to change from paying for services to paying for outcomes.
With respect to Cannon vs. Kleinke — there’s no comparison. Cannon is an armchair political pundit and is an economic generalist with no personal experience in the health care field. Kleinke’s career has been heavily involved with health care management. Compare and contrast:
http://jdkonline.com/
http://www.cato.org/people/michael-cannon
There’s a simple reason why the rules of market economics don’t apply to health care. In healthcare, it’s the sellers which make the most important purchase decisions for the buyers. Having never worked in the health care field or even worked with health care professionals, Cannon doesn’t understand this and simply applies traditional economic theory to health care. But it’s a beautiful theory, ruined by the above ugly fact. It’s why US healthcare costs nearly twice as much as anywhere else, yet delivers inferior results.
– Larry Weisenthal/Huntington Beach CA
Off subject, but still, I’ve often wondered how long Hillary wept when the wall fell, I figure Barry was too stoned to know it happened.
@openid.aol.com/runnswim: Good point about it being a survey and not a poll. I checked the methodology of the survey and at the 95% confidence level, the margin of error was plus or minus 1.6%. I dumped my stats book awhile back to see how that rates. I know you are a big supporter of the law. Last week another doctor posted on another thread here and he was dead set against it. It would be interesting to see the two of you debate the topic from your perspectives.
As for the insurance, my private insurance went up 33% after the bill was signed which is a far cry from any other rate increase I’ve ever experienced. If I had a lot more trust in the VA, I would have dropped the private coverage. Without getting too far off topic, it takes two months just to see a general practice doctor. I need a hip replacement and have been told the technology they use is way old. They also have a tendency to treat the patients like shit. I almost walked out on them awhile back. When you go for an evaluation you don’t anticipate being talked down to or having politics injected into the matter. Be told about what a great guy Obama is has nothing to do with X-rays.
As far as the original topic, everyone I know has had rate increases and/or coverage changes to the tune of less for more since this law was put into effect. There has to be a better way. And yes, from a Constitutional standpoint which to me is the main issue, the mandate is unconstitutional. A very bad decision with serious consequences down the line for our individual rights.
http://www.jacksoncoker.com/physician-career-resources/newsletters/monthlymain/des/PresidentialPoll.aspx
Hi Another Vet:
The insurance companies rushed to raise their premiums because of looming ObamaCare rules requiring regulatory reviews to approve rate hikes. The White House predicted that rate increases would moderate, beginning this year, and that’s been proven true. Industry wide, rate hikes this year have only averaged 4%, which is astonishingly low, considering what’s happening in medicine. Hip replacement surgery costs vary widely, $20K to $40K, as a relevant example. Whatever the market will bear.
I worked at 3 different VA hospitals, earlier in my career, including an 8 year stint at the Long Beach (CA) VA Med Ctr. I’d be happy to discuss the various pros, cons, pitfalls, and advantages of VA medicine/surgery via private email, if you’d have an interest. Just Google my name and you should immediately be able to get my address. You can use a pseudonym and a temporary email account, if you wish.
I’d love to have the opportunity to have an online debate here with another physician. Perhaps Curt could invite the other doc to do so and create a space for us to have this debate.
Regarding the survey you quote, the key feature is the degree to which the docs “surveyed” are representative of docs at large. They don’t even say if it is an “opt in” survey (as most of these are) or a survey in which random docs are contacted. “Opt in” surveys have huge disadvantages — the people participating are the people who are most motivated to have their opinions heard — in this particular case, I’ll bet there is a huge over-representation of private practice surgeons and other procedure-oriented specialists who are afraid of having their ox gored.
– Larry Weisenthal/Huntington Beach CA
@openid.aol.com/runnswim:
You said that Obamacare is supported by primary care doctors and “academic” doctors. Odd, most primary care doctors that I speak with are dead set against Obamacare. As to the “academic” doctors, would that be university professors who teach at med schools that just happen to be physicians or do you mean Ph.D.s who generally have nothing to do with medicine?
Also, why don’t you explain to everyone here, since you support Obamacare, exactly what it is you do and how you get paid? Are you in private practice, one that bills the patient directly, or are you paid in some other way? You’re a lab rat, right? So do you have any contact with the patient directly, or just their treating physician?
You see, folks, it makes a big difference how a doctor practices. If he is in private practice, as most doctors are, and is responsible for his own office, staff and equipment, then he either bills the patient directly, or accepts assignments and bills the insurance company with the patient being responsible for any remaining balance. But if the doctor works for a set salary, say because he is employed by a lab or in the case of the “academic” doctor who works for some university on research or as part of the teaching staff, then his interest in how much the government will cover his fees are moot.
Hi Retire, in answer to your questions and comments in #6, above.
Since January 1992, I’ve been entirely in private practice, save for serving on the volunteer clinical faculty at the University of California Irvine medical school. I’m board certified in Internal Medicine and Medical Oncology and since January 1992, I’ve received 100% of my income from direct patient payment and from insurance company payments and I continue to receive 100% of my income from these sources. My medical practice, which is a small business, has employed between 8 and 10 people at any one time during the past 20 years. I’ve given Curt (the webmaster of this blog) a standing invitation to visit my facility at 16512 Burke Lane, Huntington Beach CA 92647 at any convenient time (he’s a “local”). I hope that he does stop by some day; I think he’d be interested in what we do here. My background is available at: http://medpedia.com/users/110
With regard to support of the Affordable Care Act by primary care doctors, here are statements from the American Academy of Pediatrics, the American College of Physicians, and the American Academy of Family Practice:
http://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/AAP-Commemorates-One-Year-Anniversary-of-Affordable-Care-Act.aspx
http://www.aafp.org/online/en/home/media/releases/2012/scotus-aca.html
http://www.acponline.org/pressroom/aca.htm
I am a member of the American Society of Clinical Oncology (an association of about 30,000 cancer doctors). Here are statements from my organization:
http://www.asco.org/ASCOv2/Press+Center/Latest+News+Releases/ASCO+News/ASCO+Statement+on+the+Passage+of+the+Patient+Protection+and+Affordable+Health+Care+Act
http://chicago2012.asco.org/ASCODailyNews/Disparities.aspx
As I wrote, the doctors who oppose the Affordable Care Act are chiefly procedure-related specialists, such as surgeons and some interventional cardiologists, who get paid for doing procedures. The Affordable Care Act aims to change reimbursement from being based on procedures performed to healthcare outcomes obtained. This would gore the ox of doctors with incomes based primarily on performing procedures.
When I use the term “academic” doctors, I am not talking about non-MD researchers or basic science lecturers. I am talking about doctors (including surgeons) practicing medicine at academic medical centers, such at the University of Texas Southwestern Medical School, the University of Texas San Antonio Medical School, Baylor University College of Medicine, and so forth. These doctors are, in general, overwhelmingly supportive of the Affordable Care Act, although all of us recognize that it is a work-in-progress, imperfect first step.
– Larry Weisenthal/Huntington Beach CA
@openid.aol.com/runnswim:
Larry, while those organizations may support Obamacare, I would be interested in knowing how many of their members do. You see, I once belonged to AARP, but don’t agree with their political agenda, and consequently dropped my membership. But that is different than belonging to a medical association where you membership gives you a) access to advanced research and technology and b) credibility.
I am very familiar with a number of oncologists from Texas Oncology. None of the doctors I know there support Obamacare and call it what it is; socialized medicine.