Sunday, April 3, 2011

Let’s Enslave Doctors To Save Obamacare!

Here we go. Obamacare isn’t even in place and already the left has discovered a horrible, horrible flaw: doctors aren't slaves. As long as doctors have the freedom to choose to forgo the glorious adventure of Obamacare and engage in private practice on their own terms, the system will fail. Why? Because greedy doctors don’t want to work for free. And if they won’t work for free, then Obamacare will bleed doctors until it collapses. What’s a good Marxist to do? How about stopping doctors from escaping the system?

When England socialized its medicine, it banned doctors from engaging in private practice. Why? Because socialized medicine doesn’t pay doctors enough to want to be doctors. As long as they could “opt out” of the socialist system, they would opt out, and the system would fail. So, to keep doctors from abandoning the system, England banned private practice, so they had no choice. Of course, many still found a choice by escaping to America or giving up being doctors. Now England’s facing an acute shortage of doctors.

Given this experience, only a fool would try to repeat that in US, right? Actually, no, plenty of fools are ready to repeat that here. Enter the recent attacks on what is being called “concierge medicine.” “Concierge medicine” is the term used to describe a system where primary care physicians stop trying to see a hundred patients a day and overcharging private insurance patients to subsidize their losses from seeing Medicare patients. Instead, these doctors limit their practice to something like 500 patients a year, each of whom pays a flat fee, something like $1,200 a year (or $100 a month), for the right to see the doctor any time they wish.

This is a great system. Why? Because the doctors are making solid profits that keep them in business. AND they find that by limiting patient numbers, they actually get to know their patients, they get to spend time with them, and they get to offer them dramatically improved health care. AND they don’t have to deal with the stress of seeing a hundred patients a day just to break even under Medicare’s horrible pay structure. AND, patients love this system.

I belonged to one of these a couple years ago and it was great. For a flat monthly fee ($60 a month), I could go to the doctor any day (or every day) without an appointment. The only time I ever had to pay more was if I had to see a specialist. The doctor spent anywhere from 20-40 minutes with me depending on the issue. The doctor and his staff were unbelievably helpful and they wanted to find anything possibly wrong with me and fix it, even if it wasn’t the issue that brought me in, because preventive care kept their costs down. So I saved a ton of money, the doctor made his money, I got healthier and everyone was happy.

Who could object to this? Socialists.

A full court press is just starting to attack these plans. Their reasoning is pure socialism: so long as we allow these doctors to set up their practices like this, they will have no incentive to participate in the socialist system Obama is setting up. That means people who are stuck in Medicare or Obamacare and who “can’t afford” to pay the “outrageous” fee of around $100 a month (i.e. one cable bill) will be relegated to the crappy system that Obamacare has created. Thus, we must stop these evil doctors by taking away their right to create a better system, lest they end up destroying the socialist paradise that Obamacare envisions. . . where doctors are overworked and underpaid and treat patients like hamburgers on an assembly line and don’t even know their names.

And don’t think I’m kidding or exaggerating:

● Whined AARP policy director John Rother: “What we are looking at is the prospect of a more explicitly tiered system where people with money have a different kind of insurance relationship than most of the middle class, and where Medicare is no longer as universal as we would like it to be.” Right, because choice sucks and because we can’t have unequal pigs. (Don't forget, AARP gets rich pimping Medicare-related insurance.)

● Squealed Glenn Hackbarth, chairman of MedPac (a commission that studied this issue for Medicare): “My worst fear . . . is that this is a harbinger of our approaching a tipping point. There's too much money [for doctors to pass up concierge medicine].” Right, it couldn’t be that Medicare doesn’t pay doctors enough to be doctors, it must be those evil rich people stealing doctors away. Let’s take away their right to protect themselves from our idiocies.

● Fellow MedPac comrade Robert Berenson called concierge medicine a “canary in the coal mine” and said “the lesson is, if we don't attend to what is now a relatively small phenomenon, it's going to blow up.” Yes comrades, stamp out this capitalist horror now before it exposes the insanity of our new system.
What you have here is the ideal system. Doctors are happy. Patients love the plan. It’s cheaper care. It’s better care. So the liberal response is: we must kill it before it exposes the horror that is government-managed health care! That's pretty despicable.

Is it any wonder liberalism always ends with death camps?


Joel Farnham said...


I like the concierge doctor plan. It sounds like something that works for any who want it.

Did your doctor take "one night stands"? I mean to say, a patient who only wanted one visit for one specific problem?

LL said...

You could easily see clinics and hospitals being set up in Mexico, staffed by US professionals, catering to US clients. That won't address the problem nationwide, but it would tend to service those living within a couple hundred miles of the border -- and those with serious problems not covered by ObamaCare.

T_Rav said...

Sounds a little like the Roman Empire in its final days--making occupations hereditary, restricting economic freedom, and all that. And it worked out pretty well for them, after all...wait.

Yes, comparing us to the Roman Empire might be a little over the top. But if--I mean, when--doctors start having wage controls imposed on them, I'm going to scribble Mark Twain's quote on my door: "History does not repeat itself, but it rhymes."

(P.S., if doctors are already facing wage controls, don't tell me. I don't feel like writing on my door just yet.)

AndrewPrice said...

Joel, They did, but those were more expensive. The idea was to develop a regular set of clients who paid each month and whose health he could "manage." So he tried to see mainly the flat fee people.

It was actually really a great plan. I almost never had to wait to see him. They would call me at home just to remind me to come get things checked out every once a while. They even handed out free medications for certain basic things -- the stuff you get at Walmart for $4.

I had a long talk with him about how he could make money and he explained it to me and it was really incredible that both the doctor AND the patients were getting a great deal. That tells you a lot about the problems with things like Medicare doesn't it?

One other interesting note, the insurance people fought him tooth and nail to stop him. They even had him charged criminally twice because they said the flat rate plan was "selling insurance without a license." It took two ruling by the state Supreme Court to clear the way for him.

AndrewPrice said...

LL, I think that's coming. You already see medical tourism being set up in places like Thailand and Dubai. And if you could get a cheap airline to somewhere closer like Mexico, then I suspect people will start doing it if things get too oppressive here.

The doctors I've spoken too really are at the end of their ropes with the amount of regulation and things being imposed upon them by our government and the attorney bar.

We seem determined to kill our medical system. Very strange.

Joel Farnham said...

I wonder when it will become illegal for doctors to leave their profession. That seems the next logical step.

AndrewPrice said...

T_Rav, If you ever get the chance to talk to any doctors, I recommend it. You will be shocked. I've spoken to several doctors who have stopped taking Medicare/Medicaid patients because (1) they lose money on those patients and Medicare expects them to over-charge their private clients to make up the difference, (2) the restrictions on what they can and cannot do are stifling, and (3) they have rules that do things like preventing them taking cash for certain procedures if they also see Medicare patients or rules that say that if they ever give a discount to any patient, they must automatically extend it to all Medicare patients under threat of being jailed for defrauding Medicare (even if it's a one time discount to someone who genuinely needs the help). It's insane. There isn't a more heavily regulated industry in the world.

And one response to this has been doctors leaving the system and refusing to see Medicare/Medicaid patients. Some even refuse to see insurance patients. Basically, these doctors have decided they are going to run their own practices the way they want. And that doesn't sit well with leftists/democrats.

AndrewPrice said...

Joel, You mean the East German model?!

In all seriousness, I don't think they will do that. BUT, I think liberals will happily convert doctors into quasi-state-employees and will regulate what they can charge, who they can see and under what terms. If they don't do that, then doctors will continue to flee the government-run programs and there won't be enough doctors to handle the patients in the government-run programs.

Of course, even if you turned all doctors into slaves tomorrow, that will only work until they stop practicing entirely or they flee the country. And I'll bet Obamacare has already reduced the quality and quantity of applicants at medical schools.

Eventually, we'll end up like England, importing unqualified doctors from third world countries and hoping they don't bail out as soon as they can.

Ed said...

Liberals never cease to amaze me. I heard something this weekend too about Medicare now starting to offer old people the right to NOT take life saving procedures. Can you say "rationing"? How long before that becomes a requirement. "Oh gee, you aren't worth saving, sorry."

AndrewPrice said...

Ed, I heard that, but I didn't hear the details or I would have mentioned it. That's pretty obviously the first round. Next they will require a doctor to certify that the procedure can save you. That's when a lot of people are going to be shocked that there are indeed "death panels," they just aren't panels.

Liberals no longer shock me. They don't grasp human nature and they don't care. They just think in short term solutions -- "we need medical care for everyone, ok, everyone gets it." .... "oh, it costs too much? Pay doctors less. What could possibly go wrong?"

AndrewPrice said...

Ed, Let me add, "what could possibly go wrong" is exactly where the problem lies with liberalism. They just do things without ever thinking about the consequences. They never ask how people will react. They just do it and then wonder why it all went so wrong.

Tennessee Jed said...

The insurance people didn't think that one through. They should want primary care to be a flat fee that becomes uninsured just like the old days. Private insurance companies should be engaged in major medical insurance to pay for big ticket items, not routine care. Of course, under Obama, his real slate is to control prices and premiums in a way to drive out private carriers. Just as with Doctors, he wants to keep them from charging what is needed. There is a song by the Rolling Stones titled "Memo From Turner, " from the soundtrack of the movie "Performance." In it, James Fox portrays a hit man on the run from the mob who is given some mushrooms and hallucinates Mick Jagger as a mob boss." Point is the last line is where Jagger tells the people they now "all work for Me!" which is the real point of everything B.O. is doing.

AndrewPrice said...

Jed, I think that's right. Private insurance should be for large expenses, not day to day stuff. The day to day stuff should be as cheap as possible and as easy as possible to get so that people remain healthier in the long term. Insurers should love this system. But right now they've latched onto the current model and they aren't willing to give that up. It's short-sighted.

There are, however, some big companies stepping into this concierge medicine field and I suspect that their model will eventually win out because it just makes so much more sense.

But in the meantime, the system will limp along getting worse and worse until it collapses. And the whole time, the Democrats will do their best to plug the holes by punching more holes in the rest of the dam. I think ultimately, this is about control and the Democrats want the government to control healthcare. They don't care about quality or cost, they only care about control. And patients and taxpayers will suffer for that.

That should bother people a lot.

BevfromNYC said...

Actually Andrew, they DON'T just do it and then wonder why it all went so wrong. When "it" goes horribly wrong they just double down on "it". They will swear that the idea was perfectly conceived, but was executed by "the others" which is why "it" went horribly wrong. Lather, rinse, repeat...

AndrewPrice said...

Bev, That's absolutely correct. Doubling down on stupid seems to run in their blood.

Plus, don't forget that they will also try to scapegoat people. The guy who tried it last time wasn't any good.... the evil rich/doctors/Republicans who stood in the way betrayed them.... "unknown" people undermined the plan.... the mysterious bad economy that suddenly appeared is to blame.... etc.

It's never their ideas that were to blame.

What's just as interesting to me is that when you break it down and you ask a liberal "would you continuing working just as hard if I cut your pay in half?" They will always say "hell no!" Then you ask them why someone else should keep working if you cut their pay and they say... "they can afford it." It's incredible hypocrisy.

T_Rav said...

Andrew, you don't have to tell me. One of my friends down here is a doctor's kid, and I hear all about how much burden the medical profession is under, even without ObamaCare.

And you're exactly right on the control thing, though I would add it's also due to liberals' inability to comprehend that there is no such thing as a free lunch. Blocking people from leaving the profession or refusing to treat Medicare cases is the next logical step when doctors react to this disastrous plan, and I have no doubt wage controls will be coming soon if they can get away with it. This is basic "Third Way" thinking, and Obama and his entourage are the poster boys for it.

AndrewPrice said...

T_Rav, I think that's right. I think the leaders of liberalism are ideologically interested in controlling people and getting them dependent on the government for the things they need in their daily lives. But average liberals don't think that way, they just want a free lunch and they suffer from a great deal of envy/spite and they don't like the idea that other people have things they don't.

So that leads to the leaders trying to grab as much control as possible and the rank-and-file just going along because they think they are getting something for nothing. And neither group cares or realizes that people will react by refusing to work or offer their services or by cutting corners. So it comes as a huge surprise to them when things blow up and start to go wrong.

At that point, they reach for the next most obvious short-term solution... wage and price controls. And when that doesn't work, they'll try something else like rationing, tax hikes, forcing people to take inferior care, importing foreign doctors (i.e. cheap labor), and finally telling us "we've been betrayed and we'll just have to tough our way through it."

Liberalism is a mess. It really is a destructive force that does an incredible amount of harm to the world and the people in it.

DUQ said...

If we're going to fix the health care system, doctors need the freedom to come up with arrangements like this. If liberals are going to whine and scream every time a doctor does something creative, then they we need to start convincing the public to ignore liberals entirely because they have nothing to add to the debate.

AndrewPrice said...

DUQ, I am all in favor of ignoring liberals. I think they have little to offer except destructive "solutions" and injecting blame into every situation. They are best ignored.

Unknown said...

Andrew: When I retired and no longer had company benefits, I decided to see what would happen if I used Medicare instead of buying a private plan (COBRA was ridiculously expensive). I got to see my regular doctors and a few specialists, even when I developed the cancer. It was some time before I found out that the only reason they took me was that I was a longtime patient or referred by a longtime doctor. None, absolutely none of the doctors were accepting new Medicare patients. And that was before Obamacare made things drastically worse.

Writer X said...

Since the great and wonderful Obamacare has passed, my health insurance has increased more this year than in all previous years while at the same time the insurance pays for less than it did in the past. It is one big huge cluster@@@@, courtesy of our government. Meanwhile, people who I know who work for the federal government continue to have incredible coverage and pay very little for it, thanks to our ever-increasing tax dollars.

I would very much be in favor of paying for a private, concierge service that is as far away from government meddling as humanly possible. It sounds like it would work and be a valuable service for people; naturally the federal government would want to get involved and screw it up. Rant over.

Ed said...

Andrew, Your right that only the panel part is wrong. This system will cost too much. The only way to fix that will be to deny care to people. They are going to find a way to prioritize that, and I think they'll base it on who has the most "value" to society. That will be the young and the healthy first and the old and the infirm last. I think that's horrible, but that's what they will do to control costs. It's inevitable.

Ed said...

Andrew on your point about liberals nothing thinking how people will react, I think you outlined it perfectly when you said they were short term thinkers. They see a problem and they want it fixed. They don't think about what will happen in a year or five years.

AndrewPrice said...

Lawhawk, That's becoming a common story. It just doesn't make any sense for doctors to take Medicare patients because they lose money. So unless they have a pre-existing relationship with the doctor, it's getting harder and harder to for Medicare patients to find doctors.

AndrewPrice said...

Writer X, I think your rant is well taken. First, everyone's insurance premiums have been soaring -- last year and this year and probably next year too. Secondly, government employees are of course exempt from that because the government looks after its own and it doesn't mind robbing the rest of us to make that happen. Talk about a coddled group of good for nothings!

Finally, from experience, I can tell you that this is a good system. They're apparently cropping up everywhere, so you may want to look around. Excluding federal intervention, I think this is the future -- a flat rate plan combined with some sort of catastrophic care insurance.

AndrewPrice said...

Ed, That is how it's happened everywhere else. Once the government starts rationing, the only factors is ever uses is "usefulness to the state."

I'm glad you remembered the short-thinking issue! I think that explains a lot.

StanH said...

I wonder if witch doctors will come back into vogue? My dad’s nephrologists, is from India by way of Britain, and tells of the horror stories that envelope the British medical system. He’s of the mind that Americans will not put up with the waits, we’ll see. He does not take anymore Medicaid/Medicare patients.

Notawonk said...

i have a nephew in medical school, and he is proceeding in his studies, yet with great interest in how this will work for his profession. he and his fellow students are NOT happy campers, so much they trekked to austin to have a word with some folks.

AndrewPrice said...

Stan, I don't think Americans will accept the waiting either because it's not in our nature to accept bad things as they are and to assume there is nothing we can do about it.

In terms of taking Medicare patients, my dad's doctor only sees my dad because he saw him for years before he ended up on Medicare. He doesn't take Medicare patients otherwise.

AndrewPrice said...

Patti, They shouldn't be happy campers. The government right now is intent on making it impossible for them to structure their practices as they see fit, impossible for them to earn a living, and unforgiving about things like student debt. In effect, the government is looking to make them into slaves. And I can't see that making doctors happy.

Best of luck to your nephew! :-)

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