Is Your Doctor Getting Ready to Quit?
Finally, physicians are concerned that universal health care will compromise their ability to practice according to their own best judgment and conscience.
President Obama’s “stimulus package” included $1 billion for “comparative effectiveness research” in health care. Writing in the Wall Street Journal, Harvard professor Martin Feldstein noted that the government’s eventual goal is to use this research to cut costs and ration medical care by “implementing a set of performance measures that all providers would adopt” and by “directly targeting individual providers … (and other) high-end outliers.”
In other words, your doctor would be rewarded if he practiced according to federal guidelines and punished if he strayed too far from them. Such guidelines must necessarily be based on statistical averages that cannot take into account specific facts of individual patients. But good physicians must consider precisely these specifics when treating their patients.
If you have abdominal pain due to gallstones, who should decide whether medication or surgery would be “most effective” for you? The doctor who felt your abdomen, heard your heart murmur, saw your ultrasound, and knows your drug allergies? Or the bureaucrat who got his job by telling the right joke to the right person at the right Washington cocktail party?
Most physicians I know aren’t in the field primarily for the money, although they do expect to be fairly compensated for a job that requires four years of college, four years of medical school, three to seven years of internship and residency, and often one (or more) years of additional specialty fellowship training.
They do it because they love their work, including the ability to apply those years of training to benefit their patients. They passionately want to use their skills according to their best medical conscience. To practice good medicine, a doctor must therefore be left free to use his reason, his experience, and his judgment — i.e., his mind. ObamaCare would destroy your physician’s willingness and ability to use his mind for your benefit.
If ObamaCare passes, some doctors will grit their teeth and still try to do their best for their patients. But they will have to waste hours arguing with bureaucrats, while their less conscientious colleagues can just punch a clock and go home. How long will the better doctors continue working under a system that constantly punishes them for their virtues? And when the good doctors finally retire or quit in frustration, what kind of doctors will remain?
In Ayn Rand’s classic novel Atlas Shrugged, one of the minor characters was surgeon Dr. Thomas Hendricks, who explained his reasons for “shrugging” and quitting medicine as follows:
I have often wondered at the smugness at which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind — yet what is it they expect to depend on, when they lie on an operating table under my hands? … Let them discover the kind of doctors that their system will now produce. Let them discover, in the operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man they have throttled. It is not safe, if he is the sort of man who resents it — and still less safe, if he is the sort who doesn’t.
The policies of our current president and Congress have turned too much of Atlas Shrugged from fiction into fact. The government has already assumed unprecedented control over the banking and automotive sectors of our economy. Health care is next in its sights.
If ObamaCare passes, thousands of doctors will follow the fictional Dr. Hendricks and shrug.
Will your doctor be one of them?
This poll has already been thoroughly debunked over at 538.
PJM is slacking off.
Peace.
DS
Good article. Simple message is embedded. Physicians are bailing…I have actually begun to tell parents of children that have a long term problem that they are best to seek care elsewhere, trading the personal service of a private practice for the impersonality and constant personnel changes of an academic institution.
The problem is worse than stated. The physician population in many specialties is skewed to the over 55 group and this includes most of the highly skilled and obviously the most experienced surgeons. The Clintons cut the GME funding dramatically limiting the supply. With or without Obamacare our manpower shortage is acute and this will be worsened by the over sixty group just saying screw this and leaving.
Medicare is going to cut funding further for GME leaving the importation of Third World specialists as the only alternative…expect loosening of the Visa regulations and licensing requirements to supply the “cooperatives”.
Certain specialties will withdraw entirely….those that don’t need hospitals will be first. It will become a cash only system for them…Dermatology will be at the top of that list.
“Of all tyrannies a tyranny sincerely exercised for the good of its victim may be the most oppressive. It may be better to live under robber barons than under omnipotent moral busybodies. The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated, but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience.”–C.S. Lewis
Too many do-gooders want to volunteer everybody else for their socialist programs. Please don’t volunteer me!
regards
ObamaCare becomes more unpopular the more we find out about the details. Instead of actually solving real problems like allowing interstate competition between insurance companies and instituting tort reform, a group of people who aren’t in the field and have no experience or qualifications in medicine are attempting a massive and unecessary overhaul of a complex system they know nothing about.
If I were a doctor, I’d consider early retirement too.
Asked my Indian doctor (from India) what he thought about Obamacare.
He has been at the VA hospital for 15 years.
“I really don’t care about the money-
I punch the clock and go home- (smiling)
My wife has a good job and we get by,
People in India make less than one percent what we make.”
I figure he makes about $125,000 a year.
but the family probably pays 30-40 percent taxes.
He said Obamacare only scares those specialists and surgeons that make lots of money,
and are concerned about their lifestyles.
I can tell you one thing-
our conversation scared the hell out of me!
Ours is–talking about moving his practice (top flight guy) across the Rio to Mexico or retiring. Opens the possibility of a whole new industry in Northern Mexico. Stay tuned!
I imagine one of the more difficult things a doctor has to do is inform a patient; or his/her family that his illness is incurable and he or she is going to die shortly.
This kind of situation is also probably made much more agonizing for everyone involved; the doctor, the dying patient, the family and friends when all of them know that the patient could have completely avoided the disease by living a less risky life style.
Considering Atlas Shrugged, what was known about Barrack Hussein Obama leading up to the election and the methodical steps of havoc and destruction he (and Congress) have brought down upon all of the citizens of America (not just doctors) in little more than 100 days, it is not only possible, but very probable that it is now too late to treat and heal the wounds.
In other words it is time to summon the bugler and notify the grave diggers to begin. Elections have consequences. This time they may already be fatal for our country.
Hmmm, so we can expect a massive shift from medicine to, hmmm, maybe, real estate, if a health care package passes?
Just as a simple reality check; given the current job market, isn’t medicine looking better, rather than worse as a career for those with the brains to even consider it.
If doctors go back a notch or two in salary to what the guys who used to come visit your home used to make, (relatively speaking) that is hardly the end of western civilization as we know it. Boo hoo.
For a fact of that 45% there maybe 5% of that will follower through and quit. They will, just like in Canada, become civil servants and take their cheques from the government, count on it.
And, Dr Hsieh, in another chilling example of Atlas Shrugged presaging the Obama reality, there was the deployment of sonic weapons at two San Diego town hall meetings. http://www.godlikeproductions.com/forum1/message878314/pg1
Paul Hsieh scaremonger:
Fox runs wild with “not scientific” IBD poll
“Several Fox News media figures highlighted a recent Investor’s Business Daily/TIPP poll which found that “[t]wo of every three practicing physicians oppose the medical overhaul plan under consideration in Washington, and hundreds of thousands would think about shutting down their practices or retiring early if it were adopted.” However, according to statistician Nate Silver, the poll is “simply not credible,” and Fox News itself acknowledged that the poll is “not scientific.”"
Shame on you.
The poll has already been debunked
http://www.fivethirtyeight.com/
If Medical students are more concerned with making tons of cash than actually helping the sick, perhaps they should join the mortgage industry scum that are now heading in droves into the oil and gas business.
If Medical students are more concerned with making tons of cash than actually helping the sick, perhaps they should join the mortgage industry scum that are now heading in droves into the oil and gas business.
A perfect example of the Left’s biggest exception to their moral relativism: Don’t you dare try to make a lot of money or else you a “scum”.
Well, Middleman, I already think you’re scum for thinking your own preferences on how much money people can and can’t make should be law, so I guess we can call it even.
Scum.
There is virtually no disclosure about methodology. For example, IBD doesn’t bother to define the term “practicing physician”, which could mean almost anything.
You obviously did not read the study as they pointed out that responses by retired physicians were not included.
I don’t think 45% of physicians will quit. What will happen is that more and more will go to a cash practice excluding Medicare and, if Obamacare passes (which I doubt), they will phase out of that, too. Canada banned private care and a large number of physicians emigrated. The ones who “become civil servants and take their cheques from the government, count on it.” are the ones who either had no option to leave or chose for other reasons to stick it out. I used to attend an excellent laparoscopy course in Saskatoon. Then, one year (1992, I believe) the meeting was cancelled. All the surgeons who had run the meeting had emigrated. Their places were taken by foreign graduates.
There is a lot of information accumulating about the changes occurring right now. You might search for retainer practices and the other terms that suggest how rapidly this trend is growing. Very soon, you will be unable to find a primary care physician who accepts Medicare and a growing number of specialists are doing the same.
If doctors go back a notch or two in salary to what the guys who used to come visit your home used to make
Are you also going to decrease the cost of medical education back to what it was then, relatively speaking?
What none of you can articulate is why a doctor should give up one penny of his or her earnings for YOU. There is no reason.
“In a recent editorial published by Investor’s Business Daily, associate editor (and PJTV.com regular) Terry Jones revealed stunning poll data showing that 45 percent of American physicians “would consider leaving their practice or taking an early retirement””
Is Terry Jones the same IBD ediotr who claimed Steven Hawking wouldn’t be around if he lived under the U.K.’s NHS?
IBD has no credibility. None.
Your desperation is showing.
Just as a simple reality check; given the current job market, isn’t medicine looking better, rather than worse as a career for those with the brains to even consider it.
Actually, the best segment of the job market is “government paper-pusher” (that might not be the exact job title, but it’s the essence of the job). In terms of the amount of work you have to do versus the rewards, it can’t be beat.
So, when we all work for the government, we’ll get our tax revenues from where, exactly?
We’ll become like the old Soviet quip about work and pay, “They pretended to pay us and we pretended to work”. Fits in nicely with the whole “let’s pretend the world works like we think it does” Leftist mentality.
I’m a candidate for president. Here are the main elements of my medical reform plan.
Our free enterprise, the American heartbeat is stressed! One prob limb is the growing roll that lost their health insurance along with their jobs. My Loose Penny Program, a capital injection, will instantly begin to repair our economic muscle, but to create jobs, mission critical steps must be taken.
President Obama needs to exit the teleprompter trail, cold cream his charcoaled eyelids and summon our fast foods, supermarket; Target and Wal-Mart CEO’s into the White House to ink my proposed infusion solution. Obama went to Cairo. He can palaver with KFC. The loose change in your pocket will make the health care diff rinse our economy requires.
Every chain must participate in our Loose Pennies Program, regardless the size of their enterprise. Our purpose: an additional two-cents in their cash registers. For every item registered we want two pennies extra, added as patriotic gratuity.
This is not a government mandate. Anyone can refuse to pay the voluntary tip. Burger, fries and a drink totals six extra cents, pennies off the pavement. Regardless what we purchase at the market; we are only pitching in some loose change out of pocket. 40 items at the supermarket could easily be $150. Does another 80 cents inhibit your generosity?
A worker chosen by the workers to represent them can meet with the managers to approve the total pennies for everything out the door the week before, dividing that total by everyone’s hours worked.
Then we include up to $2 dollars extra for every hour in the worker’s paychecks. A 5 % deduct for a Medical Malpractice Pool is also doable, which employers don’t have to match, so their sticker prices won’t rise from an extra cost of doing business. The chains won’t be squeezed from our Medical Assurance pay raise that, on management’s tally sheet, is a plus minus wash!
The worker’s pay increase won’t come out of management’s pocket, but work place production is guaranteed to grow. When someone quits, the crew will likely ask the boss to leave them pick up the slack, so they earn more money!
The overage, beyond the $2 dollars hourly extra in every pay, goes to interest bearing Medical Savings Accounts, with the worker’s name on his or her portion. President Obama can ask those on the low end of the economic chain to divide their bounty, or the President can order the take home half in cash, with the balance going to grow these proposed medical savings accounts, a health care solution ten million people strong.
The medical savings account, as a health care solution beats health insurance!
Insurance companies are dedicated to making money, not protecting the sick from financial disaster. When an insurance company cancels your policy because you have an expensive disease, they don’t refund your premium. But with a Health Assurance Savings Account, when you quit or get fired from the job, your medical savings account goes with you!
After a year behind the fast food counter, a 40-hour per week worker could have more than two grand in their Health Assurance account. Ten million uninsured people at the bottom of our economic food chain might not have health care insurance but all would carry Health Assurance! In the event they don’t feel right they have access to medical care, and a second opinion, because the money to pay is there. When it’s your money, unneeded procedures evaporate.
Other companies, besides the fast food chains could have the option of halving medical savings accounts, in lieu of providing an insurance policy for their workers. A sensible choice solution eliminates insurance company monopolies.
This works for the medical professional, too. You accept the charge, the doctor swipes your Medical Assurance card and the money is debited from your Health Assurance account. The insurance bureaucrat is out of the mix.
This proposed over-the-counter voluntary two-cent gratuity, $344 dollars monthly doesn’t bash our budget. These out of pocket pennies go to the working not so rich, without government intrusion. Government Bureaus are by-passed, but to investigate anonymous charges about businesses that may be cheating workers.
In all the dry cleaners add a nickel to every shirt pressed, a dime for every dry cleaned piece. In all the family operated dry cleaners, medical savings accounts will replace the worker’s share of their family’s health insurance.
This 2 cents extra covers 90% of all the minimum and lower wage jobs in USA, juicing the recovery by pumping the bottom of our economic chain, enriching the people most likely to purchase goods with their money! Fresh dollars spent creates jobs. Those in low echelon jobs, working 40 hours a week will have $80 extra weekly in his or her pay envelope, the diff rinse between scraping by and getting ahead; the advantage of $76 after a 5% set aside for our Medical Malpractice Pool, $40 in their pay with at least $36 going for Health Assurance savings.
Millions of uninsured not so rich people building Medical Assurance Accounts will directly benefit from this voluntary deal. We gain from tipping our pennies to working folks, as these millions of uninsured won’t be crowding emergency clinics for care, which we all pay for. Emergency health care costs are infected by the actuarial projections of how many uninsured people might use emergency room walk-ins for care during the course of any year.
People in min-wage jobs with Health Assurance accounts pay for access on a need-to-be seen basis. In addition to medical savings accounts, the two cents gratis can secure a million defaulting mortgages, a contribution to neighborhood health as foreclosed house disease is a cancer that devalues the whole street.
For the rest of our uncovered citizenry, doctors and dentists must be allowed the volunteer opportunity to do tax deductible charity, treating them. A charity patient is anyone without insurance. The plan: doctors do $50,000 in charitable medical services and deduct the 50 large off the top of their federal tax. Then, after all the deductions, the doctors take an additional half off their bottom line; twenty-five thousand or half, whichever is greater.
Medical professionals could perform $100,000 in charity and deduct $50,000 off their tax, and because they only owed $49,000 in taxes, earn a one thousand dollar income tax credit. This health care approach cost effectively makes sense.
Doctors won’t be at the mercy of an insurance companies,’ take it or leave it payment. People suffering with unaffordable premiums, with pre-assurance from their physicians, will begin to cancel their overpriced insurance policies.
Every doctor will have a waiting list of patients waiting to be classified as charity. Doctors will have more patients, their work incentive, freedom of income tax.
Isn’t this one-line change in our tax code easier to digest than a thousand page med-reform stick-it-to-us vaccination, unread even by its authors, our congress? Would insurance company’s shills show up at town hall meetings screaming, “It’s a communist plot! Down with their two cents for medical savings accounts?”
Every doctor and dentist will have a sign on the door: “No insurance? I’m here.”
These ideas will enrich our economy from the bottom up, possibly save a million mortgages, and insure access to health care services for many, if not all the millions of uninsured people, leaving rip off insurance companies to self reform, according to our free enterprise marketplace.
The long-term solution to our health care prob limb is free medical education for doctors, dentists, and all related personal, our goal one hundred thousand doctors graduated every year until we have one family doctor for every thousand people. A national marijuana tax could fund this program, as could a three per cent reduction in military contracts. Politicians are sometimes eloquent identifying the issues, but it is those who finance their campaigns that govern the solutions.
In this light, the above proposed change in our tax code, encouraging doctors and dentists to treat the uninsured as a deductible charity, could not pass either House of our current congress absent a public outcry demanding it. michaelslevinson dot commie
Let me guess, they’re going tot quit because they love medicine so much their only choice is to turn their back on it, even though people have invested time and money and trust in them, they’re going to just up and quit so they can, I don’t know, be on the Maury Povich Show.
I can see some of them leaving. But, where would 45% go? And, we haven’t seen all the details of ObamaCare.
My bet is that, in order to overcome the differences in race on health care issues, i.e., life span, diabetes, blood pressure, infant mortality, once the death panels start rationing resources for white/senior areas, the former ACORNers will divert resources to inner cities and pay significant incentives for formerly suburban doctors to work downtown.
Oh and incidentally my doctor, and neighbor, already quit last year.
A GP making about 75K who grew tired of having the insurance companies running her office. They had a staff of 17 to deal with the insurers and had only 6 docs.
And she is behind Obama Care is a big way.
I don’t think I’d put up the effort to finish 8-12 years of school just to work for the government.
So, jharp complains in post 16 about using an IBD poll and then in message 21 uses the anecdotal evidence of his “neighbor” quitting as support for ObamaCare.
F-ing classic!
Whether this particular poll is accurate or not is irrelevant. Doctors from all levels of the industry are extremely uneasy about the prospect of socialized medicine, and many are planning to leave healthcare altogether if the bill passes.
I run a business which handles health insurance coverage for medical facilities and specialists offices; we have offices and clients in seven states, and the message we’re getting is a uniformly negative reaction to the longer hours and lower pay that Obamacare would guarantee. Medical professionals are intelligent people; they would rather work less, make less, and have more personal time than work more, make less, and have less personal time.
The movement has alrady started. I insure a multi-state specialist’s practice who has begun to formulate a business plan for a boutique medical facility in the Bahamas, should government-run healthcare come to pass. His firm has begun to explore this as an option because he learned about it from a family member on the west coast whose surgical practice has started to look into the same thing. His practice learned about it at a trade show from a company that handles the legal work involved in moving a medical practice offshore; that company was started in June of this year.
The irony of the situation is that the current administration pats itself on the back as being a champion of the lower classes, while attempting to ram legislation through which would virtually guarantee that only the wealthiest Americans would get access to the best care.
Amazing! Within the first 21 comments we have David S, jharp, Middleman, vivo, Now and Then, and Dwight show up to tell us, again, how stupid we all are, that we are misinformed and that IBD has no credibility. Someone needs to tell George Soros that his transparent, lying (but seriously overpaid) butt-kissers are the ones showing the desperation they accuse others of possessing. On the other hand their insightful comments and analysis probably explain the flood of support that Obamacare is winning among America’s lamentably misinformed population. Let’s see, Rasmussen Daily Tracking Poll has 55% against Obamacare on Wednesday of this week up from 53% the week before Obama’s remarkably successful joint session of congress lie fest. What percentage of disgust and disbelief will 5 more TV appearances this weekend generate? Obama is a failure almost as great as the efforts of the local troll crowd.
It’s about time someone considered the doctors’ point of view. It’s already bad for doctors with Medicare, Medicaid, government regulation of insurance, emergency rooms and more. Doctors are drowning in arbitrary edicts and paperwork. There is a reference above to doctors quitting “even though people have invested time and money and trust in them.” What about the huge investment of time and money that goes into becoming a doctor??!! Someone else suggests that doctors should become mortgage lenders if they’re in it for the money and not because they love their work. Well, what if they do just that because they don’t want to work as slaves, which is what will happen to them under socialized medicine?
Obamacare, or any other variation of socialized medicine is evil. It violates the individual rights of patients, insurance companies, hospitals and above all, doctors. It will destroy medicine.
I know that this poll is total bull**** from 538, but to be honest, I think it would be great if Obamacare results in a purge of the medical profession. All the sociopaths who just went to med school to get themselves a garage full of beamers can go do something else, opening op a lot of spots in the hospitals and practices for actual human beings who became doctors because they actually want to heal people.
The article doesn’t mention that bureaucrats at the big insurance companies already make all the decisions now. The only way to avoid being told by bureaucrats what is done is to pay cash out of your own pockets. Right now doctors in my area already display a sign saying
Medicare Advantage plans not accepted, only the original Medicare. So really what is your point? The currently available HMO plans are accepted much less that original Medicare and pay doctors even less and have much more restrictions. Private insurance HMO plans are much worse than government health plans such as Medicare.
Dear Bloggers:
The problems are already real for physicians, make no mistake. To answer some of the questions above:
1. What will they do just quit? Yes. Do you go to work for 16 hours a day and expect not to get paid? When you work 80+ hours a week and all the money you can earn goes to ‘overhead’ and you can’t get paid, you quit. I suppose if you don’t need money, and don’t mind paying to work 80+ hours a week you can continue.
2. Is it really that bad? How much does a decent family meal cost in New York City at a good place? How much to take you and your friends to a good concert for the night? Several hundred dollars, say 500-1000? That is more money than a General Surgeon will get paid to save your life in the middle of the night, and it takes more time than both! Appendectomy=$450 (please subtract overhead from payment)
3. Is the American public really so blinded as to believe that they can demand free things from hard working people for ever, and expect the services? Apparently yes, see ACORN and OBAMA and Health care proposals.
You people have no clue about the few that have done so much for so many for so long. The average age of a General Surgeon in the United States is well over 55, and they are already in short supply. Many will retire, some will be adminstrators, some will just do other things that are profitable. The question is: What are you going to do when you need your life saved in the middle of the night and they are gone?
Pete
13. venividivici,
I personally love make money, but I’m not in an industry set up to help the sick.
Should doctors be rewarded for their hard work? Absolutely, but their prime mover should be healing and helping, not pushing product for pharma companies and thinking being a doctor is going to be the way to strike it rich.
American lower classes may have access to top of the line medical facilities and treatment, but if they knew before each treatment what the cost would be for them, I’d be interested how many would opted out.
Health Care Reform may still have a lot of fleshing out that needs to be done, but reform is needed. The status quo sucks and is unsustainable in the long run.
jharpisajoke:
As much as I’d like to spar with you today I can’t do it.
It’s a beautiful day and the golf course has beckoned.
But by all means stand behind the preposterous claims of IBD. It only hurts your cause.
And don’t forget the teabaggers slogan. “Keep your government hands off my Medicare”
1. David S: “This poll has already been thoroughly debunked….PJM is slacking off.”
Au contraire! PJM is running true to form.
Ooops! Even more and more support for Obamacare! Today Rasmussen has opposition at 56%, down yet another percentage point from Wednesday. While the American public would like to see some measure of healthcare reform–they are interested in the total socialist destruction of it. Every day Obama looks worse and worse and increasingly incompetent. Then again, 48% of the population saw that back in November. Couldn’t have been too hard to see. Too bad we can’t have an election again today. I suspect Obama would have his posterior handed to him. Probably won’t get better between now and next Fall either. Must suck to be a liberal when the shallow thinkers start to wake up.
As a physician I want to make some observations on the comments. First, it is none of your business what so ever as to what doctors make. We used to live in a free society before Obama, one were a person was free to make a profit, seek to improve his financial well being and generally be able to live with a minimum of restraint. Now we are committing a wrong by considering how to make a living.
Second, taking care of people is a pain is the back end. People should be rewarded for even considering taking care of such people as Dale (one of the people above).
Third, I was recently in the hospital for one week and had big time surgery. The hospital charged $75,000. The doctor charged $1500. It doesn’t take much to understand who is getting the money. The same surgery 10 years ago would have had a hospital charge of $20,000 or less and the doctor charge would have been $2500. Thats right, doctor charges have been going down dramatically. You need to begin looking at hospital administrators as the evil ones.
But don’t worry. I also taught medical school and can assure you that we have people in the pipeline who are content with less money. They also are dumb as hell and refuse to read and learn their craft. On top of that the government opened the borders to foreign doctors and they are flooding in. The problem, they are not as well trained and their ethics are questionable. I also am an expert witness so see a considerable number of malpractice cases. Almost all are foreign doctors. So keep them coming as I make money on that issue.
Good luck America, you will need it.
I’m not real happy about the current mess with our billing/insurance/paperwork. I’m very skeptical about government Public Options etc. but, and this is important, that poll seems completely insane. If they had argued 20% or 15%, I’d give them the benefit of the doubt, but 45%? No, there’s no way that represents our industry at all.
Medicine isn’t just a professional practice, it is also a business. The cost of liability insurance caused me to drop surgery and do only an office practice 5 years before I wanted to. If you can’t make enough to pay the expenses of doing the practice, like any other business, you have to stop.
You have to live while doing 4 years of college and spending at least 80 hours a week in study in order to get into medical school. Medical school also requires 80 hours a week to pass, and residency may take even more!
This may take loans to live on that have to be paid back.
Factor in 11 to 13 years of your life being put on hold after high school, working twice as much as the average person just getting there, and continuing into practice.
Do that, then you can fairly criticize me for not liking Obamacare limiting my practice, business and income.
Most reasonable people already understand all this without being told.
The average age of the typical trauma surgeon is 55, and they still work 80 hours a week.
If you think limiting their pay just to keep them “humble” will somehow help you when you have your auto accident, think again. They may not elect to continue working more than 40 hours a week or even less.
The number of students applying to medical school has dropped over the last 20 years and those who choose to train as trauma surgeons even more so.
So for those of you who think this is just gravy, now is you chance to step up to the plate and do your share! Or don’t cry when no one else does.
Doc
“Amazing! Within the first 21 comments we have David S, jharp, Middleman, vivo, Now and Then, and Dwight show up to tell us, again, how stupid we all are, that we are misinformed and that IBD has no credibility.”
Yeah, I noticed the same thing. Obviously, one of the kids from the Obama team has been assigned this web site. I guess this is their strategy, to continue to ridicule anyone who doesn’t believe what they believe.
One more thing- if hospitals are ever required to perform abortions, every single Catholic hospital will shut down rather than perform abortions.
The elephant in the room is not how many doctors will quit, but that the collectivists want to add 47 million new people – that’s their own numbers and while we could break it down and prove it is bogus that’s not the point of my post – to the ranks of the “insured” without adding any new medical professionals or facilities.
I also love the posts from the scumbag liberals denigrating the doctors for wanting to make money or not provide them with healthcare for free. They must either be unemployed or stupid enough to think that as the revolution continues they will be spared from the same fate – wage control – because they are progressives. Those that actually think this class envy/warfare sh*t is a good idea deserve the death they will suffer in the coming gulags as history repeats itself. Stalin’s camps where replete with fervent believers that just did not sit right with him.
“While the American public would like to see some measure of healthcare reform–they are NOT interested in the total socialist destruction of it.”
Ooops! Forgot the NOT. Sorry
As usual, the liberals can’t understand real world impacts.
It’s not just that some docs will quit, retire early or reduce their efforts (all of which will happen – as has been happening for decades as government control over fees has occured). It’s what happens to the pipeline of docs. My father was a doctor and I leaned heavily in that direction as I loved science, went to a top school and had top grades. 25 years ago dad recommended against it – he said between the government restrictions (even then) and law suits that I should look at law or business. So I went to one of the top 5 law schools and after 3 years of law school I started with a salary 3x what a physician would make until he finished 7 more years of school and training while making a pittance. Now 25 years later, I have throughout my legal career made multiples of what the average physician makes. A similar situation is developing with my son. So yes, if you don’t care about getting the best and brightest doctors, keep moving down this path.
Personally, I think the medical profession will continue to split between cash/private insurance practices that have the best docs who are well paid for years of sacrafice and effort and the government pay practices which will be staffed by the bottom of the class docs who are more time card punchers than dedicated professionals.
For those idiots who want a caring physician good for you – what I want is a capable physician and whether he is motivated by goodwill to humanity or buying a BMW does not matter to me.
37. sydneyj,
Don’t flatter yourself thinking posters on Pajamas Media are important enough to be deemed a threat to people from opposing political machines.
I’m just here to offer an alternative view. If not marching in lockstep is trolling, then I guess that makes me a troll. Nice to meet you.
As far as doctors on here offering their opinion, I personally am not completely sold on what the government are offering in terms of reform, but it still seems crystal clear that the current situation is not a good one.
Instead of offering the status quo of sailing into the rocks when you know they are coming, I would be interested in what alternatives Republicans or others could put on the table to make healthcare affordable for the American public. Get off your lazy ass and get a job does not apply.
It’s not the present doctors you have to worry about, it’s the future doctors. Medical schools are very expensive and if doctors cannot pay off this expense in a reasonable time, then taxpayers will have to pay for medical education. This will, of course, open up a large can of affirmative action worms.
I seem to remember affirmative action med. school admissions, in large part, doomed Hillarycare.
I stumbled in here via Instapundit. I was a regular on the Powerline Forum, which dammit, I miss, even if its demise has freed up some time for me.
I consider myself a centrist, although the righties on PL believed that anyone who sparred with them had to be a lefty.
The “death in the coming gulags” talk is such low-hanging fruit, that one can hardly resist.
But I will.
Isn’t the internets a wonderful thing where one can talk trash? One of life’s basic pleasures for some of us has become using the computer to harangue rascals and villains.
God help me, I do love it so.
Agreed the poll is crap.
My fellow docs; we will see nothing but increased demand at income neutral levels. More patients – less money each. Subspecialists will continue to handle more volume and your reports will be delivered by corporate services, timely and concise. Teleradiology, remote cardiology and pathologists whom you will never meet in person.
This is happening anyway.
Shalom,
Spindok
It does not matter if the poll has been “debunked” or whatever.
What matters is that government control of medicine is evil. Altruism is evil; sacrifice is evil; working under compulsion is evil — poll or no poll.
Socialized medical care is slavery, and slavery is evil. No poll necessary. Oh…and irrational, idiotic cries that “that is raaaaaaacist” to the contrary notwithstanding.
This is not complicated: Sudden changes break things.
If even 10% of the Medicos retire in the year after
ObamaCare passes, it will be repealed the next year.
#42 Middleman “I would be interested in what alternatives Republicans or others could put on the table to make healthcare affordable for the American public.”
1. Enact Tort Reform
2. Get the Federal and State government out of healthcare business.
3. Get Employers out of the health carebusiness
4. Remove state barriers; allow health insurance companies to sell to all 50 states — like every other business.
5. Allow people to choose their health insurance like they choose Auto insurance, Life insurance, House insurance, etc.
6. Enact Medical Savings Accounts which incent buying catastrophic health insurance through tax breaks
7. Beef up (or simply enforce) existing illegal immigation laws.
The truly destitute in need of health care can get it The Same Way They Do Now — by going into any Emergency Room. My daughter is a nurse and that’s a fact.
Enacting the above would dramatically reduce the cost of health insurance for everyone. Let the free market work.
30
Should doctors be rewarded for their hard work? Absolutely, but their prime mover should be healing and helping, not pushing product for pharma companies and thinking being a doctor is going to be the way to strike it rich.
What is an acceptable way to “strike it rich”? Rock star? Athlete? Politician who does nothing in his life but write memoirs and then con his way to the Presidency? What?
I know this is difficult for people of mediocre talents to understand, but the rest of the world does not have the same natural limitations you do, either in the way of skills-learning capability or ambition, both of which can lead to the earning of vast sums of money. You are just going to have to deal with this fact as human society evolves further and further away from its collectivist roots in the hunter-gatherer social structure. You people are throwbacks to a time when people lived in small enough groups with enough surrounding dangers to make individualism a luxury that could not be afforded. Guess what? The world has changed. I suggest you do the same or suffer continual disappointment.
Actually you know if government is going to enforce laws on me, I’d at least like a bit of health coverage in return in case something catastrophic happens. My insurance will only go so far and the Aflac duck will probably fly off when it sees the bill.
But by all means stand behind the preposterous claims of IBD. It only hurts your cause.
What you don’t seem to understand (sticking to this instance, not the millions of other things you don’t understand), is that EVEN IF IBD is off by a factor of 50% in the number of physicians who will quit, that is a HUGE problem.
And don’t forget the teabaggers slogan. “Keep your government hands off my Medicare”
Again, you use a sample size of one to “support” your point. Clearly, you are not under 40 years old, or else you’d have the incentive to actually look at the Medicare financial projections and realize what a Ponzi Scheme it really is and how it’s going to come crashing down, in one way or another, by the time someone who’s 40 now is eligible.
Socialized medical care is slavery, and slavery is evil.
Now, if we’re gonna argue slavery… we’ve been a nation of slaves since the Civil War. Once it became clear that it was no longer voluntary association that held the states together, but rather threat of war.
I love the ideas that this nation was founded on, but the nation we live in now is nothing like the nation as designed. Further, its not the Socialists that are destroying it… its politicians from both sides and unthinking fools that just scream along with their party. I’ve been hanging out on PMJ for years… and Roger Simon’s blog before PMJ was a twinkle in his eye… and I didn’t see commentary about Slavery when old GWB was in office (and he was as bad as Obama). So, in my opinion, this is just more partisan bullshit, where the Right screams Freedom, when they aren’t in power and the Left screams Freedom when they aren’t in power… and neither side actually cares about anything other than their own political agenda (which is just a bad as their opponents).
America has become full of disingenuous hypocrites, right or left doesn’t matter.
Its difficult to feel so much sympathy for a profession where the average salary is…well….(cough) in the low million or so per year. yes, doctors need help, … help being carried to their yacht from their limosine. Doctors and their insurance/pharmacutecal corporation proffiteering whores have spent millions lining the pockets of the Wilson-Right wingers in congress to block health care reform and keep medical care and cheaper prescriptions from reaching our senior citizens and the most needy on our society. But in the end, its the jackal that faces its own fate.
49. venividivici,
Oh boy, someone who thinks he’s some sort of ‘John Galt’. Middle managers don’t apply, pal.
As I said, I’m not against doctors being paid for their hard work, but their mission to be a doctor should be about treatment and not profit.
You’re right, the world has changed. It’s found out that in just about every facet of business, what you do for a quarter, an Indian will do for a nickel. No matter how much ‘talent’ you have, the bottom line will always mean more. Get use to it Galt. You, like the rest of us, are a commodity.
It really makes no difference whether or not the poll is accurate or not. Even if it is off by 80% it still would mean a loss of about 10% of the all the physicians, and the chances of replacing them all would be very low if there is no incentive to spend all those years of training. Therefore I have a proposal:
Everyone knows that elephants work for peanuts. And elephants are not daunted by paperwork or other red tape. They simply crush it as if it didn’t exist. Therefore doesn’t it make complete sense to replace physicians with elephants? But what happens if an elephant wont work? They are then chained up, denied food and beaten until they start working. This is known as “‘There will be no liberty until morale improves’.
The real question though is not if, but when can we replace physicians with elephants. After all, since the weight of an elephant averages about 9,000 pounds, one elephant could replace approximately 56 physicians (assuming that the average doctor weighs about 160 pounds).
http://www.funtrivia.com/askft/Question6532.html
Aside from major problems, e.g., are there enough elephants to replace, say 10% of the available physicians? and can they be gotten into classrooms? there are considerable benefits like having smaller classes, which can expedite their training. Another benefit is that if doctor gets angry at a patient, there will be no need for end-of-life consultations. Since there is no evidence that elephants are able to write, the savings in administrative costs alone will pay for their food. They don’t need shelter, so chalk up some more savings. Most importantly, have you ever tried to sue an elephant for malpractice? And since elephants can be trained this program will even provide a job for Jimmie Carter. He can be the Peanut czar, the only job for which he’s qualified. His other title will be the Head MaHoot. Training for the latter title is available at ( http://www.ehow.com/how_2226039_learn-train-elephant.html)
Take your pick. take away incentives and you will be left with two choices: Jumbo, M.D., or the current bunch of Jackasses in Congress telling you what’s good for you.
You’re right, the world has changed. It’s found out that in just about every facet of business, what you do for a quarter, an Indian will do for a nickel. No matter how much ‘talent’ you have, the bottom line will always mean more. Get use to it Galt. You, like the rest of us, are a commodity.
Who do you think is the person making sure everything gets managed to the bottom line? Me.
You know how people always complain about “those damn MBAs” that think they know everything? That’s me.
Every job in the country will be outsourced before mine is. I used to work in IT and I realized this was going to happen, so I did what any rational person would do and I took the necessary steps to make it unlikely to happen. The main thing I have to worry about is the top foreign graduate students coming over to our business schools and then staying. But, with the growth in their countries and the stagnation in ours, most of them are going back home to bring best practices in business management to their home countries. So, yeah, I have to help my company compete with those improving foreign companies, but my job is as safe from outsourcing as can be.
As I said, I’m not against doctors being paid for their hard work, but their mission to be a doctor should be about treatment and not profit.
Who cares what you think their mission should be? Each individual doctor gets to make that choice, not you.
# 48 Jim Rockford has enough of a list to start insurance care reform for a years worth of trial to see how those plans work. If those plans don’t work after a certain period of time then can them, if they work, keep them.
I would like to add that if part of the implied deficit neutral of the 6 plans relies on remove the fraud and waste of Medicare, then that needs to be addressed first. Otherwise, all of the laws that the radicals can invent are still practicing the bad medicine of bandaids over bullet holes.
The insurance companies are nightmares, but there is recourse. A government insurance company, by any other name, has much less recourse. The doctors will disavow Medicaid and Medicare and Obamacare and go cash. Did any of the 6 plans volunteer to reduce malpractice insurance? Doctors make bad slaves.
Dr. Hsieh, thanks for another great article.
Those commenters obsessing over the validity of the IBD poll should read the rest of the article and see if they can answer its arguments. I suspect they cannot, which is why they wring their hands over one small part of it, once again missing the forest for a single tree.
I’m seeing a parallel here…
“In other words, your doctor would be rewarded if he practiced according to federal guidelines and punished if he strayed too far from them. Such guidelines must necessarily be based on statistical averages that cannot take into account specific facts of individual patients. But good physicians must consider precisely these specifics when treating their patients.”
Hmm, this sounds strangely familiar to the situation banks found themselves in with regards to the mortgage market. That didn’t turn out too good.
There is NO SUCH THING as “obamacare.” The health INSURANCE reform being demanded will benefit everyone including the robber baron insurance companies.
If doctors will quit because of a public option then they were only “practicing” to make loads of money and we’re better off without them.
There are many many doctors who WANT this reform.
#42 Middleman
Democrat David Goldhill has a plan that I (a conservative Republican) consider orders of magnitude better than Obamacare. He details it in The Atlantic: http://www.theatlantic.com/doc/200909/health-care/6 My only changes would be that I want the catastrophic insurance to be provided by private insurance companies with very little regulation, and the health savings accounts to be provided by private companies, again with very little regulation.
Even better is state level reform, like the Utah reform already in place: http://www.forbes.com/2009/09/17/state-health-care-opinions-contributors-grace-marie-turner.html Why would anyone think that a health care system good for Florida would be good for Minnesota, Mississippi, New York, Oregon and Wyoming? The age and minority demographics differ. The population density differs. The climate and therefore the climate related diseases differ. Many progressive socialist Europeans think it’s crazy to have one system for this large a country. They certainly don’t have one system for all of Europe, even though the population size is similar.
Yours,
Tom
25. MikeD:
37. sydneyj:
Ignorance won’t make you better. Your assumptions are those of pre-schoolers. Learn how blogs work. Stop sucking your thumbs or toes or whatever.
A troll dealing with trolls is a troll: hi, pal!
Hey, don’t cry . . .
Thank you, Dr. Hsieh, for your excellent analysis and concretizing of what will happen if Obamacare, Baucuscare or any of the other fiat government conscriptions of all medical people being bandied about will mean to us.
If these wretched socialist plans go through I hope every doctor who doesn’t wish to work as an indentured public servant, with his or her judgment abrogated by bureaucrats, will quit, and by doing so will force a medical crisis on this country.
As long as I am not forbidden by law to contract with a medical person, there will be a thriving underground medical industry (i.e., we will circumvent socialized medicine with off-the-grid medical treatment, as parents now circumvent socialized education with home schooling).
This WILL happen unless the US government criminalizes my right to freely trade money for services with my doctor. Since prohibiting me from trading freely with a medical person of my choice is a distinct possibility, it’s no wonder the prison guard unions supported Obama.
Roxanne,
There are many items and services it is illegal to sell and to buy here. This does not prevent them from being sold, or bought, especially in other places. The Mexican government should work hard to encourage medical tourism. I read that free market health care in India is very inexpensive.
Yours,
Tom
“Instead of offering the status quo of sailing into the rocks when you know they are coming, I would be interested in what alternatives Republicans or others could put on the table to make healthcare affordable for the American public.”
“Instead of offering the status quo of sailing into the rocks when you know they are coming, I would be interested in what alternatives Republicans or others could put on the table to make healthcare affordable for the American public.”
[Previous comment submitted in error]
I doubt you actually are, but here goes: deregulate all health care and insurance related businesses (and all others).
The free market will then incentivize innovation, lower costs, and higher quality – as it does in every other field when it’s allowed to do so. You’ll deny this, but it remains true.
Beyond any issues of dollars and cents, or quality, the main issue is this: freedom is an inalienable right – for physicians, insurance employees, and everyone else. You have no right, using the Federal Govt as your proxy, to enslave some for the benefit of others… even if, miraculously, it turned out to be less costly and produced higher quality for everyone.
The article says “as much as a year for a routine physical exam in parts of Western Massachusetts.” I live in New Zealand. I have heard of that and worse happening here, ie, up to 18 months.
This proves that implementing such at the national level is much worse than doing so at the state level (or regional level as is the closest equivalent in NZ) even in a country that is smaller than many states in the US.
Our health system is so bad that many rightly refer to it as a “die-while-wait” system rather th
That is just with a small country like NZ with just 4.3 million people. Imagine doing that with a much larger country like the US with over 300 million people. Things would be a lot worse than doing it with NZ.
And this horrible system is what
The article says “as much as a year for a routine physical exam in parts of Western Massachusetts.” I live in New Zealand. I have heard of that and worse happeneing here, i.e., up to 18 months.
This proves that implementing such at the national level is much worse than doing so at the state level (or regional level as is the closest equivalent in NZ) even in a country that is smaller than many states in USA.
Many here refer to our health system as a “die-while-you-wait” system rather than a health system, and for many people this has proven to be accurate.
That is just with a small country like NZ with just 4.3 million people. Imagine doing that with a much larger country with over 300 million people. Things would be a lot worse than doing it with NZ.
And this horrible system is what I might have to rely upon soon as I suspect I may have to go get my head checked due to a head injury I received.
It is amusing to see these left wing morons try to dictate why a doctor should be in practice, but have no complaints about the obscene salaries made by jocks, entertainers, politicians and lawyers. I would like to see the democrats in power tax these people’s windfall profits, and tell them how much they should make.
For those getting out of residency, the average physician salary is closest to $100,000. You need to moonlight to make ends meet. Too many think that doctors are filthy rich and loaded with $$$. This is the exception and applies more to middle aged specialty surgeons.
To get to this point you have to go through:
4 years of college (loans)
4 years of med school (more loans)
3 to 7 years of residency
1+ years of fellowship
For the residency and fellowship years, you put in 100+ hours of work and earn the equivalent of a garbage man’s yearly salary. In the mid-90′s, residencies cut back the number of residents, so an increased amount of work is put on the backs of fewer overworked doctors. Remember this: when you end up in a hospital floor deathly ill in the middle of the night, the first person you will see is an underpaid resident running on few hours of sleep, an amount of sleep which would be criminal if practiced by a pilot or air traffic controller.
When you get out of residency, the challenge is making ends meet with student loans coming due and numerous bills from office overhead to malpractice insurance, and government bureaucrats looking over your every move.
Most doctors are not in it to get filthy rich, but do want to make a decent living and a comfortable life for their families. You wouldn’t fault a union plumber for wanting this, yet when a doctor wants this, he is “greedy”. And doctors want the opportunity to practice medicine, not be a desk jockey with paperwork. For every 5 minutes you spend with a patient, you have 15 minutes of paperwork, and you have to practice CYA medicine so if a patient gets an adverse event, you won’t be ruined by an ambulance chasing lawyer who gets one-third of whatever amount he sues for.
Whatever fix you think you are getting from health care reform, realize that in a 1000+ page bill that these politicians don’t read are nebulous laws written in legalese jargon that a skilled lawyer could make into anything he wanted. So any claim made by a politician to support this bill can be both a lie or a “truth”, depending on how it is interpreted by a lawyer.
One thing to remember: the type of cancer Ted Kennedy had was incurable, yet he received treatment that extended his life from a few months to over a year. Do you think that if your grandpa got this cancer, would he get the same treatment under the health care reform bill? Or would he be told to take a pain pill and die? In countries with government single payer health, cancer survivability is lower than in the US. If you wait too long, you will have a cancer that is curable become one that has spread throughout your body. Do you really want the government putting you on a wait list to get the diagnostic tests, then determine that with your now metastatic cancer, you are more likely to die in a short time, so why waste resources on you? Think about that.
Health Care Reform Proposal in a nutshell:
Imagine, if you will, a company that is productive, innovative and effective. They produce more widgets and better widgets at a pace and efficiency that is rivaled by none. The executive board of directors, who have no fundamental understanding about the manufacturing process or requirements, institute a plan for ramping up the customer base, production and quality standards. However, in the proposed plan no consideration is given to additional equipment, personal or expanded facilities required to meet the goal. They also include, as part of the plan, mandated production cost reduction and increased quality requirements without consideration for the acquisition of the additional resources needed to meet these goals.
Ladies and gentlemen, I submit that a goal is not a plan.
Doctors shouldn’t quit, just form real unions and strike against Uncle Samuel. Obama gonna send in the troops against them?
Thanks for another excellent editorial Dr. Hsieh!
To commenter #3 “Too many do-gooders want to volunteer everybody else for their socialist programs. Please don’t volunteer me!”. While it’s a sarcastic comment with the right spirit, I’d suggest that it’s a big mistake to concede that altruism is the good. The people asking for sacrificial victims are the opposite of good, and it’s time we hold them to it. Nothing less can reverse the disastrous path we’ve been on for the past 100+ years.
Jay Robbins: Private health insurance has been such a complete failure that government intervention is absolutely necessary. Private HMO health plans offer very limited coverage at best with most doctors refusing to accept HMO patients. Medicare has fewer exceptions and pays faster than the HMOs and costs much less to run. I cannot see why doctors would accept the low HMO payments, the frequest refusals, and the excessive paper work imposed by the private insurance companies. Surely most family doctors whould prefer working and being paid by private patients without interference by the insurance companies but what really is the difference between being told by private insurance companies what to do and how much will be paid for the services or being told the same thing by government insurance companies?
Those who wish to go to school to become a doctor should do so because of their desire to heal the sick. It shouldn’t be because they want to make a boatload of money. That’s not to say that an individual who dedicates a large part of their life to training and hellish hours shouldn’t be well compensated. They should be and under the Obama plan they will be. They’ll make enough to drive a nice BMW or Mercedes. No more Rolls though. Those days are over, not just for doctors, but for a variety of professions. It’s called topping out and getting paid what your worth and not a penny more.
Hans: Consider that: HMOs are government-created, regulated, taxpayer-subsidized entities. Now the very institution that created the problems are now calling for reform (expansion and control) of the policies they created. “Real” reform proposals will include relaxations on government stranglehold regulations and tort reform. It will call for the implementation of tax exempt health care savings accounts and plans to effectively reduce the massive “welfare” health expenditures. Finally, it will consist of real dialog on the exodus of government intrusions in free market contracts (doctor- patient) and health care all together.
So, in my opinion, this is just more partisan bullshit, where the Right screams Freedom, when they aren’t in power and the Left screams Freedom when they aren’t in power… and neither side actually cares about anything other than their own political agenda (which is just a bad as their opponents).
America has become full of disingenuous hypocrites, right or left doesn’t matter.
You can’t see out of the left-right box, and so have given up. Fine. Shut up and get the hell out of the way, then, and leave the field clear for those of us who know that the world is far larger than that little box. We’ve got work to do.
For a fact of that 45% there maybe 5% of that will follower through and quit. They will, just like in Canada, become civil servants and take their cheques from the government, count on it.
“Oh, you’ll do something, Mr. Rearden…”
Oh and incidentally my doctor, and neighbor, already quit last year.
A GP making about 75K who grew tired of having the insurance companies running her office. They had a staff of 17 to deal with the insurers and had only 6 docs.
And she is behind Obama Care is a big way.
And you think IBD has no credibility? Unless you meant “behind” as in eight-ball, you’re better off that she quit; you need a doctor a bit more in touch with reality.
There are undoubtedly a lot of doctors who are in favor of a socialized system, but what invariably shuts them up is when I point out to them that if that system were so much better, why not take all the like-minded doctors and patients, and set up that system just for yourselves? Leave the rest of us (and the government) out of it.
The fact that such systems must be set up by force rather than by individuals free to opt in or out of it belies the naked truth about its nature (and about the ideology behind it).
Dr. Hsieh sums my thoughts very well. I’m early 50s, if I must work for free, I’ll move to the 3rd world as a missionary where my skills will be appreciated. My wife has already started new training so we can go as a team.
Dear Trolls:
Whether or not this is a good poll, it does point out one significant fact: we will lose doctors if this plan passes. The question is, how many doctors can we afford to lose while adding tens of millions of people to an already-overburdened system? 10%? 20%? Add to that the thousands of young people who will NOT go to medical school because it’s not worth it, and you have a crisis.
And no, nurse practitioners will not be able to take up the slack. They are wonderful with triage and primary care, but not trained in vital areas like surgery or cutting-edge chemotherapy. There are also not enough of them, and they, too, have to be able to afford crippling malpractice insurance costs. Figuring that in, many will stick with a 2-year degree instead of pursuing the masters level and practicums necessary to become an NP.
Try thinking about that — oh, sorry, thinking isn’t your cup of TEA. Well, just enjoy your end-of-life care in a few decades.
As much as I respect doctors, I’m glad I’ve never needed one except for very minor ailments. I don’t like doctors and I never will. Sorry, Docs. lol
Dr. Dall,
Just remember to come back to the US in about 10-15 years. If Obama’s politics have continued at their current pace much of the US will be included in that 3rd world segment.
Ratatosk (in comment #52):
You quoted my line “Socialized medical care is slavery, and slavery is evil” (in comment #46).
Then you said “[I]n my opinion, this is just more partisan bullshit, where the Right screams Freedom, when they aren’t in power and the Left screams Freedom when they aren’t in power…”
That is silly. You don’t know me, and yet attempt to categorize me? You don’t even ask me any questions about my position?
If you have a point to make, or want to make a rhetorical point, do so clearly and in proper context. Attempting to attack someone you don’t know does nothing more than make you look foolish.
P.S. to Ratatosk (re my comment #81): Don’t mean that to sound rude, with the word “foolish” and all. Just wanted to point out that we should exercise more care and diligence before coming to a conclusion and before accusing someone of something.
Conceptual conclusions should be appraised by logic.
I’m not worried about the current generation of doctors. I’m confident they’ll be replaced by a new generation of doctors who are happy to operate as cogs in a giant government-run machine.
As a Doctor I can recognize the problem of massive social cranial rectal inversion. We need to value the valuable whoever they are and stop the ridiculous valuations placed on some individuals and institutions.
Doctors, if large enough numbers band together, can bring this
kremlinization of our health care system to a screeching halt.
They could simply take the following steps:
– Doctors could quit en masse, as suggested in Atlas Shrugged.
There is no way a government owned system could be enacted
if enough Doctors just took a hike. The breakdown in the
sytem would occur almost immediately. Dr. Obama and his
team of ‘medical experts’ would have to back down. The
public would insist on it. Admittedly, this would be a
brutal way of going about it which is why I prefer an
alternative approach:
– Doctors could refuse to treat any member of Congress, Senate,
Federal, State or Local government, their staffs and family
members (though they could continue to treat military,
police and national security personnel). Government run
health care couldn’t be pulled off the table fast enough.
The Democrats might even start to warm up to tort reform.
I know these measures would probably be too tough for most
Doctors (they, as a whole being infintely better people than
the clowns writing this legislation) but they would be
effective. One can only dream.
Dr. Hsieh’s analysis is correct. The results of the poll are not surprising. Ask anyone, including those who are critical of Dr. Hsieh’s comments, whether they are willing to live as a slave, with the prices and practices determined by a bunch of bureaucrats who have no personal or professional interest in the welfare of patients. By what standard does a patient get “rights” obtained by the violation of the rights of a doctor in a free country that fought a civil war to outlaw slavery?
<I.They’ll make enough to drive a nice BMW or Mercedes. No more Rolls though. Those days are over, not just for doctors, but for a variety of professions. It’s called topping out and getting paid what your worth and not a penny more.
Why do you want to put Rolls-Royce out of business? They make a damn fine automobile.
I guess in your ideal world, only Obama would drive a Rolls, right? Because he’s “worth it” in your eyes.
Excuse me if I don’t give a f*ck about your tabulations of people’s “worth”.
The Rolls-Royce driving top %1 are always the same regardless of right, left, upside-down, or inside-out.
Let’s get real, leftist don’t care about people or healing, all they care about is usurping power.
Let’s make a “wage panel” for all you doctors. Since I’m not a doctor and I’m generally in great health I think you all should make about $100 a year.
in 1990, one operation paid for my rent for the month. now, after almost 20 years of yearly fee reductions and no cost of living adjustments, it take me 10 of the same operations to pay one month’s rent. my income has literally dropped 10-fold. if these fee reductions continue, i’ll be forced to either move far from my current location, which means lost patients, or, i’ll be forced to quit. the latter choice seems more appealing.
and the fee that i’m paid for this surgery, is the same paid to similar specialist throughout the US. in other words, unlike all other professions that reward experience or extraordinary skills—think Pro Basketball, the legal profession, etc—we are paid the same no matter how good or poor our skills. there is no stratification for excellence. a free-market economy with respect to physician payment would not only correct this issue, but allow the market to determine value.
we hear that the cost of medicine grows at 3 to 4% per year. yet, physicians only account for 10% of all medical costs, and our income is reduced each year! (so even if we were paid nothing; the US would only save 10%). this means the other 90% account for the increases, and should be the target for cost containment. (and by reducing our fees, the government has also reduced their tax collection from this group.)
As a physician with almost 30 years in practice, and a masters degree training in health care administration and public health I would add the following, very lengthy post for consideration:
The “Executive Summary” is this: Don’t expect notions about someone’s vocation to “cure and heal” to fill the huge expanse occupied by modern medicine, in this world. Don’t expect that the notion of artificially restricting the Healthcare segment of the economy, will allow for the same rate of technological advancement in Healthcare. Don’t expect that this notion of artificially restricting the Healthcare segment will provide for the same or better healthcare, delivered in a timely manner, in hygienic, safe, well-maintained facilities, with ready access.
1. “Curing” and “healing” are the functions of miracle workers, not health care providers. Physicians, nurses, health technicians work within the real world and the real world economy to ameliorate the effects of disease, injury and aging. Health care providers can only use their training, talents, efforts, along with the resources they have at hand. The resources are the technology, materials, diagnostic discoveries provided step by step by ongoing research, engineering, technological advance and production/manufacturing within the economy in which the health care system operates. In this current age of medicine, it is this technology and its surging momentum, that represents a large part of the increase in health care costs. Who is going to tell the engineers, technicians, production workers, mechanics, assemblers and other workers at Westinghouse, GE, Siemens, etc, that their segment of the economy has suddenly, arbitrarily, even capriciously been isolated from the rest of the economic activity and scheduled for wage and price controls? Who will ensure, and how will it be ensured, that the technological momentum and productivity will be maintained while arbitrarily being price-controlled, and thus deprived of natural compensation for the goods that are brought to the community as a whole?
2. And what are the goods delivered to the marketplace? The needs, and demand met? The largest part of the increase in needs and demand is for more health care for the aging population. 300 years ago, 40-45 was aged. Check the average age at death statistics, even for the wealthy, 300 years ago, and compare it to the statistics of today. That aging population, by the way, includes the aging workforce. Today, people at this age are mid career. For labor involving significant physical exertion, 40-45 is definitely aged. That workforce,n order to keep working, requires treatment, including surgery, for a variety of combined age and injury-related conditions New techniques and technology have made this treatment available, more effective and with more rapid recoveries, and this new Healthcare capacity is being used, in a big way. Is this new capacity supposed to come at no new cost? How!?
3. The workforce ages not just because people live longer, but also because some people live more actively, and because the time devoted to professional and technological training and education and necessary experience increases as technology moves forward and related economic activity increases. The more highly trained, skilled, experienced workers, as they move through their career, must have medical care for certain age-related, inherited conditions. Besides providing for reasonable comfort and satisfaction in life, the care must be delivered in an effective enough manner to help the person to continue working, being productive for themselves, their families and their communities. These workers also play other roles in the community, in sports, recreation, the arts, politics. They have maladies that interfere with these roles. All these maladies continue to demand amelioration – ie. “Healthcare”. This “HealthCare” also involves the application of new techniques, technologies, materials, at increased cost. Or, if not at increased costs, how!?
4. Comments have been made here, repeatedly, implying that a physician or other health care professional, technician or worker should train and work to simply or even mainly to “cure and heal”. Where they have implied no need for attention to just compensation, these comments are devoid of any ethical or practical weight. Such a comment can only reasonably be directed to individuals with a strictly religious vocation, such as priests, monks, nuns and sages on the mountain top. Physicians, nurses, health care providers, healthcare workers of every stripe live in the material world. They have ethical, moral obligations to their own health and well being, to their immediate and extended families, and to their community. This obliges them to bring other talents to the table of humanity, including the table of social commentary and political debate. Physicians and other healthcare providers who don’t do so in at least some way risk becoming less able to even see the reasonable goals of treatment for their patients. Beware of those medical care givers who don’t participate, who don’t reasonably consider their own well-being and the well being of their loved ones. So removed from the experience of the average citizen, such a caregiver may drift into an egomania or other distance from reality. Even with good intentions, this distancing can move medical caregiving and medical decision-making in a dark and damaging direction. Even such a caregiver’s input into the associated political arena of healthcare planning can become darkly affected – it has happened before.
5. Imagine, as a high school student, presenting a lender or risk-bearer with a business plan for a medical career. How might it be funded? As we all know, without substantial family wealth, the debt incurred for a highly competent course of college-level and professional education and training runs into the hundreds of thousands of dollars. This reality, along with physical and mental skill requirements, is part of the “Barrier to the Market”. At any time during this course, disease or injury could eliminate or deeply impair the ability to repay this debt. By the time the individual makes it into medical practice, he or she has worked innumerable hours, including overtime and double time hours at no wage or a wage far below any legal minimum wage. The individual now has debt repayment requirements on top of having deferred years of earnings into taxation at one of the highest tax rates. A growing family is probably also part of the financial, physical and emoitional load in this picture. This doctor must be able to work effectively enough and long enough to at least repay the debt in this scenario. This is not an attractive business plan for a lender. By the way, subsidizing this education and training with taxpayer dollars doesn’t eliminate the cost, it just shifts the cost, and eliminates some important incentives.
This reality is why the posts above regarding medicine as a “good job” in this economy, represent a totally inadequate analysis of the physician’s reality. This is also why many physicians in primary care, at mid-career have less net worth than, for instance, a firefighter, or a skilled laborer ( such as a skilled welder) at the same age. Surgeons do better, sometimes, much better. Not many surgeons drive a Rolls Royce, but many surgeons do drive a BMW, a Lexus or an Acura. I also know plenty of x-ray technicians, or other health care technicians, who drive a BMW. a Lexus or an Acura.
And again, a surgeon’s training and skill is anywhere from substantial to truly remarkable. I have worked with professional athletes, musicians, fighter pilots, other professionals with substantial skills, so I have some basis for comparison. As other posters here have noted, who do you want working on you?
The best physician or nurse is one who is skilled and focuses on resources, the circumstances at hand, and an understanding of limitations,. Focus, skills upkeep, knowledge and skills in new technology, are all strongly aided by a decent personal financial situation – a financial situation that hopefully provides a reasonable road to meeting family financial needs, and can also cover retirement or disability retirement needs that may arise. In this regard, the intention to “cure and heal” alone doesn’t cut it.
5. What are the relative economic values of a skilled attorney, a highly skilled and trained athlete or an entertainer? How does one compare this to the value of a highly skilled and trained surgeon – with a modern, well maintained office, excellent, well-trained and adequately paid office staff and operating room staff and modern, safe, hygienic facilities?. What is the value of high technology electronic entertainment equipment and recreational equipment, compared to the application of high technology medical equipment? Why is there suddenly an advantage to taking the valuation of medical services and resources out of the marketplace of other goods, services and ideas that we value highly?
Again: Don’t expect notions about someone’s vocation to “cure and heal” to fill the huge expanse occupied by modern medicine, in this world. Don’t expect that the notion of artificially restricting the Healthcare segment of the economy, will allow for the same rate of technological advancement in Healthcare. Don’t expect that this notion of artificially restricting the Healthcare segment will provide for the same or better healthcare, delivered in a timely manner, in hygienic, safe, well-maintained facilities, with ready access.
Let me tell you a little about liability and workmans comp ins. I am just a dumb building contractor. I build custom beach homes. My company builds about 6 homes a year at a average of $650,000 each. I have 4 employees and a perfect record when it comes to any liability claims. My insurance last year for two trucks myself and my four employees was $70,000 dollars.
Over the last 15 years I’ve had one accident which was my companys fault. A fender bender which did $75 damage in parts to my truck. I got sued for $250,000 and my insurance carrier paid it without an investigation. No ambulance at the scene. She stated she had a trick hip. Her over paid lawyer probably received $80,000 for his time.
I cant even imagine what a doctor has to tread through to earn a buck.
We need lawyer reform. Lets start here. Make tort reform the # 1 agenda we want.
Oh, by the way all of you libtards, we all go to work to make a living and earn for our families. The doctors are not the ones who need to be scolded, it is the lawyers. Plain and simple.
In my business the fear of being sued or dealing with the court system is non stop. A person who wants to bring suit over a piece of 2″ bark being knocked off her tree by a worker who was carrying a 2 x 4. The court listens and allows damages, just so the plantiffs lawyer will get paid. The judge and the lawyer probably play golf together on the weekend.
If I were a doctor I would change my business plan. Treat only the wealthy. Cash payment when seen. You want treatment, I will see you tommorow.
If you think that waiting lines for care are not coming you are truely a LIBTARD.
Robert, Some good points. Don’t you just love people like praetorian who tell you what your motives should be for becoming a doctor? If anyone were to tell them what their motives should be for doing their jobs (assuming they have a job), I think they would be pretty upset. As Ludwig von Mises and others clearly point out, most of the objections to others making money, getting wealthy, etc., are simply envy. They can’t admit they were not as capable as someone else, or someone screwed them. But it is never their fault, rather it is always the fault of someone else that they didn’t succeed. For them everything must be free or cheap, unless of course they are the ones making the fees. What they fail to realize is that dragging down those who do things only means that they won’t do them any more, and everyone will pay the consequences. Out of curiosity it would be interesting to know how many unnecessary tests you are forced to perform because of government regulations, and how much extra those tests cost a patient as a percentage of the total bill.
Independent of Obamacare, we have a physician shortage problem, and it’s going to get worse (aging population, retiring physicians: 36% older than 50, changing practice habits in younger physicians with feminization of medicine=shorter hours). We also have a dysgruntlement problem in older physicians, according to polls at placement firm Merritt and Hawkins. If a significant number quit early, we are in real trouble: they can not be replaced.
Build medical schools and expand residencies? In the face of a physician shortage, where will we get the faculties? We already have faculty shortages at existing schools.
And will college kids (~60% female) be attracted to medicine, knowing that practicing physicians are leaving the field?
As moraly satisfying as it may be to purge medicine of profit, we will be cutting off our noses to spite our faces. The restoration of a depleted medical workforce will take decades; decades of shortages and obligatory rationing.
I have two family members who are doctors.
People become doctors for two big reasons:
a) money (these generally are your bad doctors – gimme a paycheck, and who cares about the patient)
b) making sure their patient gets the best are possible.
Type “A” doctors are going to be happy having a government-type job: they’ll do their 9-5, M-F, and they will be happy not having to make life and death decisions, because – hey – those things are already made for them by the government. They won’t feel any stress about whether they’re doing the right or the wrong thing, because “it’s just a job”.
Type “B” doctors are the ones who will move out of country, or quit, or do something else. Or go to a no-insurance-accepted system. And those are the doctors *I* want to go to (I’ll let you all have all the type “A” doctors you want – I’ve seen them in action).
Those who haven’t decided their career will look at the tradeoffs, and not go into medicine. Over time, all the dynamic people who made US medicine the leader in the world will just not be there.
Personally, I expect Obamacare to pass, and two things to happen:
a) non-insurance practices pop up.
b) some bright Mexican billionaire will build a “hospical-city” near the Copper Canyon (for people who need/like dry air and the desert), and another near Cancun. Labor is cheap in Mexico, both for building the hospitals and the general staff. American docs could go down there and live like kings comparatively speaking, and the good ones would.
Before you express an opinion on what doctors think, how about actually asking a couple of them?
Now, if you feel that they should provide their services for near-free, don’t bother – you’re living in your illusions.
Doctors have a right (and the avenue) to retire, emigrate or change professions if they are not satisfied. They have person obligations like everyone else, and a right to choose how best to meet them.
Unfortunately for those who seek medical care, they cannot simply stop being sick, or change countries if they cannot afford the healthcare. This is obviously not the doctors’ fault or problem, but it is a serious one nonetheless, and the crux of this impasse, in my opinion.
The health insurance business grew in America to address a simple market problem: People couldn’t afford catastrophic medical care out-of-pocket. Doctors (rightfully) charge enough to earn a living, pay off their student debts, and make whatever premium the market allows on their skills. Pharma companies (rightfully) charge enough to recoup R&D costs, run their business, post a profit, and all before patents run out. Citizens (rightfully) pay what they can afford.
One problem that arises from this, however, is that physician and patient are now separated by insurer. Whatever savings the insurer gets by negotiating collective care with the provider need not be passed on to the subscriber. On the physician’s side, since most of their business comes from the insurance companies and medicare/medicaid, they are increasingly constrained to provide the care of which these middlemen approve.
The difference is that while the doctors can vote with their feet, the citizens cannot.
When insurance costs got too high and payouts too low, Americans began trooping to Canada to get drugs. Well, that’s illegal. But that’s really the citizen’s only equivalent of leaving the American health system, along with health tourism.
The US Government feels it can dictate to the healthcare providers because it has created a captive market for them: the US public.
I believe there should be freedom for both the citizen and the doctor. Let the docs charge what they want; let the insurers offer whatever plans they want. Open up a national market for insurance. Once this is done, I am in support of a “public option” that works in the following ways:
-waivers for those who cannot be insured in America to import whatever drugs they need. If you apply for a waiver, you are forced to get on the Insurance Market. If no insurer will take you, you get your waiver (with expiry date).
-opening the US market to international insurers offering health tourism options. This will reduce pressure on both the US insurers and the public. If people can “opt out” of certain procedures in their domestic coverage and get these covered by the health tourism option, it will make their profiles more palatable to the domestic insurer, and that may lead to net lower premiums. If doctors can leave America, and manufacturing jobs can cross the border, why can’t patients outshore their insurance?
Overheard in the Doctors conference room not too long ago-” When Obamacare gets passed, doctors will do one of three things. The older ones will say “screw this- I quit!”. The younger ones will say ” If you’re gonna treat me like a government employee, I’m gonna WORK like a government employee”. The third group will say (in a Hindu accent) ” The heck with this- I’m going back to India ! At least I can get some good Tandoori there!”. I agree. I already know two doctors and three nurses who are applying for Visas to go work in Australia and other countries. Myself? If I’m gonna be under a socialized medicine dictatorship, I might as well live somewhere nice. England or Tahiti maybe. Or just do missionary work somewhere- at least the patients there appreciate us ! And you Socialists can stand in line at the Government clinic for several days for all I care. Remember- be careful what you wish for; you might get it. And you get what you pay for- if it’s free, it’ll be worth what you’re (not) paying. Get ready for looonnng waits for tests, CT scans, surgeries, etc…. because it’s coming soon. I can already picture Obama planning on how to stop Docs from retiring, quitting or leaving the country- just like Clinton tried to keep the rich from leaving the country after one of his tax hikes. Soon, it will be mandatory for doctors to accept these crappy plans and Medicare. Which will worsen the problem. And as for Rolls Royces? Literally the only person I have ever seen driving a Rolls was a guy in front of me at the grocery store who paid for his groceries with food stamps and then climbed in a Rolls Royce and drove off. But thats what Liberals want, I guess.
WellEducatedCad said: “And you get what you pay for- if it’s free, it’ll be worth what you’re (not) paying.”
This is very true. However, the simple reality is that there are many people who cannot afford the American healthcare system as it stands not because they are cheapskates, but because the prices (out-of-pocket costs OR insurance premiums) are too high for them. As I said earlier, I don’t believe this to be the physicians’ fault, or a social ill for which they should pay. But it IS a social ill nonetheless. The status quo has been terrible for both physicians and patients, and that is because the insurance industry and government have a captive market in the American people. Insurance companies, HMOs and government (through medicare/aid regulations) have been dictating to doctors how to do their jobs, and doctors toe the line because, let’s face it, if the HMOs and insurers left the market, there will not be enough out-of-pocket payers to keep the system going at anything close to its current level. Patients are left with no choice but to pay what the insurers set (if they can’t get on medicare/aid) because it’s not like they have access to some other healthcare system.
If insurers were forced to compete with both domestic (cross-border) and international players, they would finally get the poke from the Invisible Hand they need to streamline their activity and offer more varied products.
Thank you so much for the eloquent article. I have seen the poor results of gov interference first hand. I agree the direction to go is more freedom (less controls) if we don’t want those providers dedicated to quality practice to leave.
Yikes – that “45%” comes from FOUR out of only *NINE* doctors who even responded to that question. How the hell is this a story?
Again, the 45% comes from a sample of NINE people. Are you getting it yet?