Monday, June 1, 2009

Democrats Awaken To Obamacare Pitfall (Video)

Look through this list of "Blue Dog Democrats" and contact one or more to urge them to reject "the government option"/single payer/rationing.

From Hugh Hewitt's Town Hall blog:

Unless enough Democrats get the message that a vote for Obama/Pelosi/Reid is a marker that will attract enormous political payback in 2010. They won't believe that unless they hear it from enough people, and hear it in such a way as to believe that their correspondents are serious about contributing to the Blue Dog's opponent in 2010 and even walking a precinct if necessary. Saving health care has to be for Republicans what killing Social Security reform was for Democrats in 2005 --a line in the sand that, if crossed, will never be forgiven.

It is amazing that neither the D.C. GOP or any of the doctors' groups have yet organized such an effort, but the Beltway creates and reinforces an insiders' ethic that enervates otherwise sensible people. But the peril to medicine is real, as the e-mail below indicates. So do something about it.

Alas, I think many of these advances will be stillborn. And yes, I expect the Obama administration to be the instrument of its destruction.

I will be the first to point out that there is enormous waste in American medical care. There's plenty of blame to go around; physicians are rarely capable economists, and rarely consider the cost:benefit ration of that extra test or that extra day in the hospital; "Nothing's too good for my patient" is laudable, but is also a screen behind which too many of my colleagues hide their intransigence. Greed is hardly unknown, though I believe far less widespread among physicians than their various suppliers. I admit to something less than objectivity on this. Medicare guidelines are often the perfect example of the adage "there's no problem that government can't make worse and more expensive".

Despite the fact that perhaps 15% of healthcare expenditures go to physician compensation, it's the convenient target. Hospitals, private payors and Pharma are very effective in the political arena. The AMA, looked upon by the uninitiated as the'voice of American medicine' is nothing of the kind. We, frankly haven't the time, nor often the inclination to participate in the political wrangling; many of the 'thought leaders' in medicine are academics, whose goals are often diametrically opposite the more than 80% of physicians who practice in the private, nonuniversity sector.

Every analysis of oncology suggests that we have a 10-30% deficit of trained physicians staring us in the face by 2020. Every academic analysis suggests one or another program, and bemoans the difficulty in attracting qualified medical students and residents to oncology. It's quite simple, really: very hard work, and declining income. Private practice physicians have seen a fall of approximately 30% since 2004. Worsening economics are right around the corner. Given the extraordinary expense of chemotherapy and supportive therapies, combined with reimbursements that just exceed a wash, it will become impossible to deliver outpatient care in more than half the venues in the United States quite soon. And then, simply put, the senior physicians will quit.

Make no mistake: most of us enjoy the opportunity to do what we do. After all, we cure cancer for a living. Hard to top that on the "Useful Professions" scale.
We also, however endure just the stressors and personal strains that you might imagine. We trade time, and inconvenience, for money. Just like everyone else in the private sector, only more so---after ten years of training after college. With the prospect staring us in the face of working harder than the average internist, and earning less: well, if I were 58, and my kids were grown and my mortgage paid: well, I'd call it a day. At 48, I'm already working on an exit strategy by 55 in anticipation of this scenario.

I could go on, but this note is far too long already. Specialists, and underpaid generalists will hang it up years ahead of their planned exit from medicine in just about any system that the Obama administration is likely to devise. They'll scarcely need to ration care: there just won't be anyone around to deliver it. Government will kill the golden goose, and then blame it upon everyone and anyone else. As usual.



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