In Response to T. Paine's Cynical Constitutionality of Obamacare
When one adds 30 million more people to the health care roles and then provides HUGE disincentives to current doctors and future would-be doctors, you tend to get a whole lot more of a demand with a drastically shrinking supply of medical service providers.
- T. Paine, June 30, 2012
Shortly after Medicare was passed. An acquaintance was explaining his opposition to providing care to the elderly. It was based on personal experience. He had stopped to get a prescription filled and had to wait, losing precious time, while an older person in line got pharmacy paperwork complete. His day would have gone more conveniently if he hadn't had to wait for some elderly person to get their medication.
Continuing friend T. Paine, the T. Paine who sends prayers and encouragement about the tour of our young Marine in Afghanistan, the T. Paine who disagrees but never disagreeably, writes in opposition to Obamacare. His opposition is partially, and unintentionally, counter-factual. It is partially speculative, and counter to more informed studies.
But factual mistakes happen with passionate advocacy and limited time. And speculation, even speculation that challenges the most diligent of studies, is fair.
The part that is factual, accurate, and speculative in a way that would provoke agreement from pretty much everyone, does reveal a basic departure of values. And, I suspect, is typical of core values of Republican opposition.
The "HUGE disincentives to current doctors and future would-be doctors" is argued against by the American Medical Association. The AMA has been a driving force in favor of Obamacare. Doctors support Obamacare. Yeah, those same doctors T. Paine speculates will leave the profession. The AMA is also lobbying for a simpler record system and for upward correction of payments to doctors for Medicare and Medicaid treatment. The only resistance to those corrections has come from Republican opponents of Obamacare. It's another case of Obamacare-is-bad-because-of-all-the-difficulty-we-cause.
The dramatic increase in medical costs that T. Paine imagines would be produced by lower supply, because of the imagined uncorrected incentives driving Doctors out of medicine and into ... I dunno ... engineering maybe, and higher demand, all those pesky uninsured who will now get healthcare. Lower supply and higher demand is the classic Adam Smith formula for increasing costs.
The demand side problem with T. Paine's economic speculation is that he compares the projected world of full medical care for everyone who needs it, with the world he wants, his desired world of great numbers of desperately ill people with no medical care. In fact, many people, not all but many, who cannot afford medical care, get that care anyway. Back when I volunteered after work in a local Emergency Room, I never saw anyone turned away for financial reasons. ERs operate that way across the country. People who are uninsured do get billed for treatment, but vast sums are eventually written off. Blood from a turnip and all.
Those costs, which come from those willing, for financial reasons, to get medical care only when desperate conditions become critical, end up going to everyone else. Insurance costs go up. Medical costs go up. Everyone who has insurance pays this hidden tax and we do it now.
The non-partisan Congressional Budget Office conducted a major study with the Joint Committee on Taxation. Here is what they say (pdf):
Premiums for employment-based coverage obtained through large employers will be slightly lower than they would otherwise be; premiums for employment-based coverage obtained through small employers may be slightly higher or slightly lower.
That's on page 8.
This also has an effect on the federal deficit:
CBO and JCT effectively estimated in February that PPACA and the health-related provisions of the Reconciliation Act will produce a net decrease in federal deficits of $210 billion over the 2012–2021 period as a result of changes in direct spending and revenues.
You'll find that on Page 3. A chart, showing year by year projections is on page 4.
But the value system that T. Paine espouses, as I see it, is the defining difference. T. Paine is willing, even eager, to throw millions of people out of any health care, as he imagines a world in which Emergency Rooms turn away injured or desperately ill people with no treatment.
So my friend T. Paine:
Is on factually inaccurate ground when he says doctors will leave the medical profession in droves, reducing medical care for those who can get it. The AMA backs Obamacare.
Is on speculative shaky ground when he thinks health care costs will skyrocket by providing treatment to those who go untreated now. In fact, earlier, less expensive care to those who now make it to emergency rooms for expensive treatment, will no longer increase costs for the rest of us. Deficits will go down. Health care costs will go down.
- Is on sandy moral ground in seeking to benefit by throwing people out of treatment in order to reduce the numbers of those being cared for.
"There is a reason," says my friend T. Paine, "why the wealthy citizens living in countries with socialized medicine come to the United States for their treatment."
And if it takes millions of Americans going without treatment to maintain an exclusive atmosphere for those wealthy guests, well hey.
Life is filled with little tradeoffs.
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You've based your argument on one giant premise, that the AMA = doctors. Burr, have you ever checked the AMA's revenue sources and membership to determine how many non-physicians are part of the AMA?
Physician membership peaked in the '60s at 70%, but as of 2008, membership in the AMA only made up 16% of revenue. A Forbes article reports on a survey by a physician reporting firm (Jackson & Coker), "Just 13% of doctors agree with their trade association’s support of the health reform law."
I think your premise is very shaky. It doesn't look like the AMA is a good proxy for doctors, so saying that AMA support for ObamaCare is the same as doctor support for ObamaCare is not the same thing. Your rebuttal to T.Paine is meaningless.
"Health care costs will go down."
What are health care "costs"? The usual word games are in play here -- do you mean prices to the consumer, prices to the insurance company, prices to the government, or costs to the provider? As you might guess, none of those are the same as the others.
"Deficits will go down."
As for the CBO deficits, I could find contradictory estimates that show why ObamaCare will increase annual deficits, but that won't convince anyone. So I'll just say that it is a matter of faith for me: A trillion dollar health care bill that disrupts an entire industry and further obscures health care prices will NOT simultaneously reduce federal deficits. I can't prove it, but I believe it.
"In fact, earlier, less expensive care to those who now make it to emergency rooms for expensive treatment, will no longer increase costs for the rest of us."
I see a couple of problems with your example. Fred has no health insurance in 2005 and goes to the emergency room when he's really really sick. He costs the hospital a lot of money from a single visit as a result.
Alternatively, you propose, with ObamaCare Fred has health coverage and, as a natural result, goes to the doctor whenever he feels under the weather. He won't have to wait until his condition has become an emergency situation, so he uses more health care now that he's covered.
In other words, Fred hasn't cost the health system less because he has insurance. He has simply spread those costs over a period of time and a variety of providers. Instead of one big bill, Fred has many smaller bills.
Second point is implied by your statement, although you didn't specifically mention preventive care. (If you weren't thinking of preventive care, ignore the rest.) I'll quote from one of my posts on healthcare:
"...Preventive care is a low-cost way of reducing health care costs for individuals, but not for large populations. It is inexpensive for me to eat the right foods, take the right pills, and exercise to avoid heart disease later in life. Those are things that we can teach.
"But the costs are not lower for society as a whole if government pays for everyone's preventative care. For example, if 10% of the population will get heart disease, it doesn't make financial sense for government to pay for preventative care for 100% of the population. 90% of those dollars are wasted, and we can't know which 90%. It still makes sense for individuals to take preventative measures, but it doesn't make sense for government to fund it as a rule."
"Is on sandy moral ground in seeking to benefit by throwing people out of treatment in order to reduce the numbers of those being cared for."
I don't believe that T.Paine made this argument, so I won't bother to argue it. I'm too lazy to click back to find out, but in this case I will have faith in Mr Paine and assume you are misrepresenting him.
I do appreciate the argument that positions of an advocacy group should not be taken as necessarily representative of a population at large. Point taken.
The deficit and health care calculations are not cherry picked or chosen at random. They are studies in some detail by the non-partisan Congressional Budget Office, which is set up for the purpose of determining such things. They conducted a joint study with the Joint Committee on Taxation. I provided links to their work, and directions to specific pages.
Your faith in T. Paine is well founded in most respects. His argument deserves the click and the link was provided. Sadly, his case was as I directly quoted.
Let’s take a look at your first assertion that the AMA and thus doctors are in support of Obamacare. The first part of that statement is true; however, the second part is decidedly not. Just like the AARP hardly speaks for all seniors, neither does the AMA speak for all doctors. Indeed, see the following link explaining where a majority of physicians do NOT see eye to eye with the American Medical Association.
Indeed a survey conducted last fall produced these following results as found within the above link:
•Only 11 percent of the physicians surveyed agreed that “the AMA’s stance and actions represent my views.” Of those who are members of the AMA, only 40 percent agreed.
•13 percent of all physicians, and just 35 percent of AMA members, agreed with the AMA’s position on health reform; 70 percent disagreed.
•Of those who had dropped their AMA membership, 47 percent said it was because of the AMA’s support for Obamacare, and 43 percent who said AMA’s ideology was too far to the left.
Next, the decrease in the amount of doctors and thus the “supply” side of the equation which you disbelievingly mocked is neatly explained in a survey conducted by the New England Journal of Medicine. (Hardly a right wing organization, by the way.) They claimed the following:
“•46.3% of primary care physicians (family medicine and internal medicine) feel that the passing of health reform will either force them out of medicine or make them want to leave medicine.
•36% of physicians would not recommend medicine as a career, regardless of health reform. 27% would recommend medicine as a career but not if health reform passes.”
Continuing, another survey of about 700 doctors conducted between April 18 to May 22, 2012 by the Doctor Patient Medical Association showed further damaging results regarding doctors in support of Obamacare. Some of the key findings of this survey are:
“…83% of respondents are contemplating leaving the industry if Obamacare is fully implemented, owing to its disastrous projected consequences. Indeed, they openly blame the healthcare law for their industry's woes.
90% say the medical system is on the WRONG TRACK
83% say they are thinking about QUITTING
61% say the system challenges their ETHICS
85% say the patient-physician relationship is in a TAILSPIN
65% say GOVERNMENT INVOLVEMENT is most to blame for current problems
72% say individual insurance mandate will NOT result in improved access care
49% say they will STOP accepting Medicaid patients
74% say they will STOP ACCEPTING Medicare patients, or leave Medicare completely
52% say they would rather treat some Medicaid/Medicare patient for FREE
57% give the AMA a FAILING GRADE representing them
1 out of 3 doctors is HESITANT to voice their opinion
2 out of 3 say they are JUST SQUEAKING BY OR IN THE RED financially
95% say private practice is losing out to CORPORATE MEDICINE
80% say DOCTORS/MEDICAL PROFESSIONALS are most likely to help solve things
70% say REDUCING GOVERNMENT would be single best fix.”
Now I am not very smart and not entirely sure what all of that stuff above means, but it doesn’t sound like it supports your seemingly erroneous assertion that doctors won’t leave their practices. Or won’t stop seeing new patients such as those on Medicare or Medicaid. Or won’t stop seeing existing patients on Medicare/Medicaid altogether. I could make a few charts, but I didn’t want to lose Mr. Myste’s support on the facts by doing so.
Here is another link with some interesting findings from the DoctorsCompany:
Next, the CBO also scored Obamacare as costing less than $1 Trillion initially. That cost has already nearly doubled with only part of it being implemented. Further, the lack of religious and conscience clauses and the required fees from everybody for an abortion fund make this whole law down right evil. Further, please name for me a single solitary entitlement program that the federal government has implemented that did not go over-budget, was grossly inefficient, or flat out did not work and alleviate the issues it was designed to fix.
Lastly, and most importantly to my wounded honor, I am NOT for throwing people out on the streets or denying health care to anyone. Indeed, if we would enact sensible malpractice tort reform, allow health insurance providers to compete across state lines, and enact a few other free market based initiatives, we would find health care costs come down considerably and thus be more affordable to far more people without chasing doctors out of medicine. In other words, more of those poor people would be covered, and those in the middle class could still TRULY afford to keep their current insurance and see their current doctors. What Obamacare does will indeed raise costs and thus hurt not only the middle class but the poor as well in the long run. If Obamacare is not repealed, I will unhappily have mountains of evidence to point to and say I told you so in just a very few short years from now.
As I mentioned to Heathen Republican, I had indeed heard of the Forbes study. It's hard to know what to make of it. The study was actually conducted by Deloitte Center for Health Solutions. It was not a survey in the normal sense of the word. The entire study was based on a single mailing to 16,000 doctors out of about 700,000 in the United States. No word on the method of selection. 501 responses were received. There was no rigorous followup, or effort to ensure representative sampling. The sample seems to have been self-selected.
The summary was written for Forbes by a conservative activist, Sally Pipes who, understandably, seems to have done some selection of her own. For example, about 44% said Obamacare was "a step in the right direction" and 44% said it was "a step in the wrong direction." Within the returned mailers, older doctors seemed more opposed, younger doctors seemed to be more in favor of Obamacare.
Ms. Pipes "selected" such data out of her Forbes summary.
Was the study itself a fair sample? I'm skeptical. It isn't as if the AMA is the only professional group in favor of Obamacare. Consider
- American College of Physicians
- American Academy of Family Physicians
- American College of Surgeons
- American Academy of Pediatrics
- American Congress of Obstetricians and Gynecologists
- American Society of Anesthesiologists
- American Osteopathic Association
- American Psychiatric Association
- American College of Cardiology
- and, of course the American Medical Association
All endorsed Obamacare and lobbied for it.
Actually, the net cost of Obamacare went up a bit with the Supreme Court ruling since the medicaid reforms are not allowed. The CBO and JTC say their estimates are essentially unchanged.
But the point you originally made was that the horrible effect of Obamacare was at least partially caused by all those additional people that would be covered.
I'm glad you are backing away from that statement now. We should leave such cold-blooded sentiments to national Republicans.
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