Medicaid for All

Thanks in part to Republican ineptitude the debate on Obamacare seems to have morphed into a debate about Medicare for All. Since Republicans cannot come up with a replacement for Obamacare the nation seems to have decided that it is not only here to stay, but that it should be expanded.

Obviously, Medicare for all is a dodge. It is really about Medicaid for all. It’s about providing substandard medical treatment for everyone, and that includes citizens, non-citizens and illegal immigrants. The plan, touted by Uncle Bernie, promises the world and assures us that we can afford it. After all, we are rich so we can afford anything. One can only gasp in disbelief at a nation with over $22 trillion in debt claiming to be rich.

In truth, for the benefit of those who think that the sky is falling or that climate change will bring about the Apocalypse, the truth is, if anything does us in, it will be the national debt. We are assured, by the best minds, that it's not a problem. That means, according to the laws of black swandom, that it's a big problem.

The surest way to increase the debt is to pretend that we are really, really rich, that we can care for everyone, and that we can provide all the latest and best medical treatment to anyone who shows up on our side of the border.

Beyond the obvious fact that putting the health insurance industry out of business will cause massive disruption, we must also point out that Medicaid for all will produce a two tiered medical system, where the poor and the middle class receive substandard treatment provided by overworked physicians, while the rich will pay out of pocket for the best care. Obviously, the best physicians will opt out of Medicaid for all. They do it already; why would they not do it in Uncle Bernie’s world.

Then again, when the medical delivery system comes to resemble the post office, why do you imagine that the same people will choose to be physicians? Why do you assume that the best people will opt for a system where the government decides how much they are going to be paid. Even today, under the Medicare system that everyone loves so much, the system reimburses far less than doctors normally charge. Perhaps private insurance is more generous, but we do not have infinite sums of money, regardless of what Uncle Bernie thinks.

A number of years ago a cardiac surgeon explained to me that he could no longer make a living doing open-heart surgery because Medicare reimbursement rates do not cover his overhead, the cost of his office, hiring a nurse, and paying malpractice premiums. Worse yet, whereas he, a highly capable heart surgeon wanted a second surgeon involved in every operation, Medicare would only pay for a backup RN.

The man was moonlighting in an ER in order to make ends meet.

If you think that you are going to receive the same medical care when we go to Medicaid for all, you are not living in the real world. Anyone who wants to control for the costs of medical care should begin by getting the lawyers out of the business. Naturally, this is not going to happen, since the Democratic Party is a wholly owned subsidiary of the trial lawyers bar.

Anyway, we now have a new report about the success of Obamacare. (via Maggie's Farm) Or better, what Obamacare is doing to physicians. The study tracks physician attitudes from 2011 to 2014. It does not cite Obamacare in particular, but since those were the first years that it cast its ugly shadow over the medical profession, I do not feel that I am taking too many liberties by saying that the study judges Obamacare.

Anyway, what hath Obamacare wrought? Why, it has wrought far more physician burnout. More and more physicians now want to chuck it all, to leave the profession. Surely, this will also make it more unlikely that the best and the brightest of America’s youth will opt for this career path. Thus, Obamacare is going to diminish the quality of medical care, because it will dumb down the medical profession.

Here is a summary of the report:

Physicians may be more stressed than ever — one recent survey found that half were thinking about hanging up their stethoscopes for good. New research continues to demonstrate the demise of doctors, with burnout levels jumping dramatically over just a three-year span.

According to researchers at the University of California, Riverside School of Medicine, physician burnout increased from 45.5% to 54.4% between 2011 and 2014. The researchers say doctors aren’t more depressed or exhausted by their home life, but rather at their jobs.

Drs. Andrew G. Alexander and Kenneth A. Ballou isolated three factors for physician burnout, according to their research:

• The traditional doctor-patient relationship has been dwarfed by the relationship between health insurance providers and patients, with companies standing in the way of fast and appropriate treatments ordered by physicians.

• Doctors are feeling more cynical as a whole, because patients don’t expect continuity of care anymore and routinely change doctors.

• General lack of enthusiasm for their work.

“It should be a treat to care about another person, but I see that too many of our seasoned physicians are frustrated with medicine, and it rubs off onto the physicians in training,” Alexander says in a university release. “Doctors have a wonderful job, yet they are inundated with numerous extraneous burdens that collectively rob them of the joy of medicine.”

Whatever could they mean by extraneous burdens? You probably know already: it’s all about the new Obamacare requirement, forcing physicians to keep electronic medical records. I imagine that this seemed like a great idea to the MIT economists who dreamt it up. But, MIT economists are not physicians. They do not practice medicine. They excel in abstract thinking… the kind that often produces calamities when translated into reality.

The story continues, explaining what is chasing physicians out of the profession:

“These are hospital purchases of medical groups, rising drug prices, the Affordable Care Act, ‘pay for performance’ in which providers are offered financial incentives to improve quality and efficiency, and mandated electronic health records,” explains Alexander. “Doctors now spend more time with electronic health records than they do with patients. Electronic health records were pushed by the government at great expense and without regard to the effects upon patient or physician health. Go into any hospital and look for the nurses and the doctors. You will find them sitting in front of computers. They are not happy, and their patients are not healthier.”

Of course, the government does not always know best. The government does not know how much time and at what expense physicians need to keep records. One physician told me that he would either need to hire staff to enter data about each patient, or quit practicing.

He chose to quit practicing.