-
I Agree With Andy McCarthy: No Special Counsel
May 23, 2013 | 5 comments
-
Issa Recovers
May 22, 2013 | 3 comments
-
Colorado Governor Gives “Reprieve” to Murderer
May 22, 2013 | 1 comment
-
Steven Crowder: Jesus vs. Muhammad
May 22, 2013 | 2 comments
-
Kaminsky’s Corollary to I, Pencil
May 22, 2013 | 2 comments
The Spectacle Blog
In my article for the American Spectator yesterday, I mentioned two New York Times articles, one which exposed the Obama administration’s “mystery shopper” scheme regarding doctor’s appointments and another when the administration deep-sixed the plan following outcry by doctors and others.
In the second article, the Times stumbled upon another fact — one which I doubt they actually understand the implications of — when they reported that “Having coverage is not the same as having ready access to care.” This is true in the sense in which they meant it, namely that just because you have insurance (or medical welfare like Medicaid) doesn’t mean you can easily get to see a doctor.
But it’s also true in the converse: Not having coverage is not the same as not having ready access to care. Indeed, self-insured Americans (probably a majority of the “uninsured”, though such data is all but impossible to find) who simply pay their medical bills directly have excellent access to health care. Have you ever heard of a doctor turning down a patient whom they knew would not only pay, but likely pay quickly? Having insurance can easily be a hindrance to getting quick access to health care these days.
No matter which way you approach it, Obamacare’s claimed benefit of increasing health care access by putting the nation on a health care form of welfare is belied by what’s happening in the real world.
President Obama, like Ted Kennedy and Jimmy Carter, basically wants “Medicare for all.” But the actions of private doctors make plain that the closer we get to that progressive utopia, the more people we will have without access to decent health care. Canada, England, and even Massachusetts are proving that to us every day, yet liberals seem intent on driving our nation’s health care system into the brick wall of socialism.
View all comments (11) | Leave a comment
More Blog Posts by Ross Kaminsky
http://spectator.org/blog/2011/07/01/insurance-is-not-access
Follow us:
ADVERTISEMENT
SPONSORED LINKS
FLASHBACK TO: 1995
-
Pope Culture
A man of faith in a godless age is hitting Americans where it hurts.
-
Why the GOP Does Not, Like, Totally Suck
Mr. and Mrs. American Spectator Reader, let P.J. O’Rourke talk sense to your kids.
-
Dames at Sea
-
In the Absence of Guns
In Britain, defending your property can get you life.
-
The Metaphysical Martini
-
Counting the Costs of Clintonism
The debacle of this president’s administration is both a cause and a symptom of the decline of American values. Unless Congress impeaches him, that decline will go on unchecked. An eminent jurist surveys the damage and assesses the chances for the recovery of our culture.
-
Chuck McHagel
It won’t take long for conservatives to scratch this presidential wannabe off their 2008 scorecard.
-
The Legacy of Old John and Mother Fresh-Roasted
-
It’s the Best Time of the Year
The American Christmas, like the songs that celebrate it, makes room for everybody under the rainbow. Is that why so many people seem to be hostile to it?
-
The Bush Crack-Up
Was the President done in by the economy, or by the politics of the economy?
Clip of the Day
ADVERTISEMENT
Oldefarte| 7.1.11 @ 12:35PM
As everyone should have learned that lived through the Nixon Administration's attempt at this, PRICE FIXING simply doesn not and will never work[unless of course, you live in a socialistic country, where the government can possibly use dictatorial powers of governmental force in order to mandate compliance, which may indeed be the case presently in the USA]!!!!!!!!!
Conservative Bob| 7.1.11 @ 1:10PM
"..we have to pass the healthcare bill to see what is in the bill..." Nancy wicked witch of the west.
The more we learn of what is in this monstrosity the less there is to like about it, which franky I didn't think was possible given I hated everything I heard about it as they crammed it down our throats.
The the hidden 'treasures' that are dripping out are exceeding my greatest fears.
Here were are again hoping that 5 out of 9 cloistered 'keepers of the constitution' see fit to continue our rights and declare this Obamanation unconstitutional.
Is anyone else tired of holding their breath hoping that a simple majority will affirm our God given rights?
We must force this government to operate within the limits set in forth the Constitution.
Occam's Tool| 7.1.11 @ 3:01PM
I lived in New Zealand for a year. My wife had severe back pain, which was covered by National Health Insurance. She had ruptured lower vertebral discs. Wait time for surgery under NHS in New Zealand: 2 years. We were back home and she had her back repaired (perfectly) at Mayo before the two years were up.
Insurance does not equal access. For more on NZs crappy health care system, go the the LIberal New Zealand Herald and punch in the search term "District Health Boards").
Thank you, thank you, thank you, Ross.
Chad| 7.2.11 @ 2:43PM
As a physician, one of the aspects of the individual mandate that makes it unconstitutional is that the mandate is predicated upon the fact that when an uninsured patient accesses the health care system, everybody else ends up paying for their care. However, this presupposes that any given individual will default on their bill -- a presumption which robs an individual of his or her freedom to be self-sufficient. As you point out, if you simply pay for your care at the point of service, you can have rapid access to excellent care of your choosing.
Nightwing| 7.3.11 @ 3:14AM
A simple solution: Require all physicians to accept Medicare/Caid as a condition of their medical license renewal.
As a matter of fact, many YOUNGER docs are becoming increasingly divorced from 3rd party payment issues. Instead, they are salaried, working for institutions and happy to concentrate on medicine and their patients.
Among the shortcomings of Obamacare are that its focus is primarily on coverage more than controlling costs.
A good first step? Ban all prescription drug advertising on TV.
Chad| 7.3.11 @ 11:18PM
"A simple solution: Require all physicians to accept Medicare/Caid as a condition of their medical license renewal."
I'm just curious as to what you do for a living, because what you are advocating in your post is indentured servitude. What makes you think that the government has the right to tell a private individual what sort of business he must take as a condition for licensure? That's blatently unconstitutional, and I would suggest that if your own business were affected negatively because the government was requiring you to accept reimbursement for services rendered that was pennies on the dollar, you wouldn't take kindly to being told you had to take it, regardless of the consequences. I have a business to run and a family to feed, and your simple solution is a prescription for a failed business model. Let me put this to you plainly -- it is not your right to tell me how to live my life, and it is none of your business whether I take govenment insurance or not as a part of my practice. If you insist on forcing this on the medical community -- guess what? We're mostly smart people who are perfectly happy to go do something else. Remember that the next time you're having your prostate examined by a foreign medical graduate.
kate| 7.4.11 @ 10:51AM
Interestingly we have many "foreign medical graduates" here in Canada. They do a fine job. Conversely, many Canadian medical graduates head for the US where they can make so much more money. After we Canadian taxpayers have paid for their training. Hmmmmm.
Nightwing| 7.4.11 @ 4:47PM
Apparently you see yourself more as an enterpreneur than as a physician if your chief focus is on who pays and how much.
Indentured servitude? Nobody "drafted" you into the medical field. In fact, many docs have had their residencies funded by Medicare----are you OK with that?
And you *must* maintain continuing education credits to retain board certification, right? Is that coercion too?
The idea that medical costs are "market driven" is a fantasy. The truth is they are REIMBURSEMENT driven by 3rd party payers with deep pockets.
Very often patients go where their insurance company wants them to go----not where a physician directs them. So the docs do not have absolute control because patients have an automatic financial incentive to follow their coverage guidelines.
Call it coercion, interference in doctors' judgement or whatever, but that's reality these days.
As for Medicare/Caid, your license is issued by the government----therefore you are already "indentured" by being given legal permission to practice medicine. And, the government can change the rules.
FYI, I am a Registered X Ray tech and all too familiar with the coding gimmicks designed to squeeze as much money as possible from the 3rd party payers to boost reimbursement. And I get pissed when my skills are used primarily as a revenue source rather than a benefit to the patient.
Sometimes I think we ought to stop and ask "What business are we in?" Is it medicine or financial chicanery?
Chad| 7.4.11 @ 10:06PM
Wow. Where to start. So, my responsibility to my family and employees to keep a viable business running equates to "seeing yourself more as an entrepeneur (sic) than as a physician," as if physicians are given a magical waiver from the effects of the laws of economics when we receive our M.D.'s. I'm sure that you would be the first to say that the physicians you know are doing quite well for themselves. Aside from the fact that this is none of your concern, you (and those of you reading this) need to grasp reality if you really want to understand where medicine is going. It is getting harder and harder for independent medical practices to remain solvent. Our practice is five years old. I employ five full-time people, and for the first three years of the practice, I was the lowest-paid person on the staff, including clerical. That is what is termed risk-taking. Even today, my salary is determined by how far above or below the margin the practice is, since everybody else gets paid first. Are you aware that Medicare has not raised reimbursement rates for physicians from 2001 to the present? Do you think the cost of doing business has remained stagnant? Don't you think that there is innovation at the microlevel of medical practice, where institutional inertia doesn't intervene? Don't tell me you understand medical reimbursement. I am in business to help people, but I am still in business, and again, I am responsible first to my family, then to my employees, whose families I help support. If I can't take care of them, I can't stay in business, and I can't help my patients.
Are you aware that Medicare reimburses 50 cents on the dollar in comparison to private insurance? If I had to see a majority of government payer insurance, my margin would be eliminated, and it wouldn't work. So stop judging. Medicare is underfunded to the tune of trillions, and Medicaid, which is on similarly poor footing, is about to get overwhelmed by a huge influx of patients from Obamacare. How do you think that is going to work?
To a few of your points:
“Indentured servitude? Nobody "drafted" you into the medical field. In fact, many docs have had their residencies funded by Medicare----are you OK with that?”
So because I chose medicine as a career I have to bend to your will regardless of the cost to my family? Yes, my residency was partially funded through Medicare, as it was through private pay. I also worked for peanuts until I completed training at age thirty – while most of my friends in other lines of work were already becoming financially stable. What's your point? Beyond that, was your college education subsidized by the government? Does that obligate you to pursue penury? I don't think so. Apparently physicians are supposed to operate under a unique double standard.
“And you *must* maintain continuing education credits to retain board certification, right? Is that coercion too?”
I’m not certain of the correlation here. First of all, board certification is internal policing of the profession, and the standards that are developed originate from other clinicians, so to the extent that this is “coercion,” it is professionally-driven. Moreover, if a physician really objected to this, they could always forego their board certification. This is not authoritarian. In addition, it is remotely related to the issue at-hand, which is “does the government have the right to force physicians to see patients on government insurance at predetermined below-market rates?”
“The idea that medical costs are "market driven" is a fantasy. The truth is they are REIMBURSEMENT driven by 3rd party payers with deep pockets. Very often patients go where their insurance company wants them to go----not where a physician directs them. So the docs do not have absolute control because patients have an automatic financial incentive to follow their coverage guidelines. Call it coercion, interference in doctors' judgment or whatever, but that's reality these days.”
Again, for those of you who have never run a practice, there is something that physicians give up to gain access to a third party insurance payers’ network of patients – a discount on reimbursement from the usual fee schedule. We accept a negotiated rate of reimbursement for a given service in exchange for this, or alternatively elect to forego participation. Everything is above the board and nobody is coerced at all. What’s the problem? It’s not as if Blue Cross is stepping in and requiring us to see their patients as they slash reimbursement in tandem. Get the difference?
As for Medicare/Caid, your license is issued by the government----therefore you are already "indentured" by being given legal permission to practice medicine. And, the government can change the rules.
Indentured: A contract by which a person, as an apprentice, is bound to service. In what way does being licensed to practice in a given state make me “bound to service?” Moreover, the state does not deign who they will or will not license. They must license all of those clinicians who meet the predetermined legal requirements set out by the Board of Medicine. My ability to practice medicine was earned through many years of training. It is not a gift of the State. That’s an enslavement mentality.
So you say you are an x-ray technician. I see that the average salary on salary.com for this position is $48,000. If the government came in and told you that they were going to cut your reimbursement in half, would you continue to work or would you find a different line of work?
The thing you have to grasp is that you can call me callous (though I’m not); you can appeal to me through your own misguided sense of duty; you can threaten me; you can try to legislate me into servitude. In the end though, I’m not your slave, and no amount of wishing will change that. So, you can work within the reality of the system to try to better it for as many people as possible, maintaining a grounding in reality, or you can tilt at windmills and wonder why the medical community chooses not to march off the cliff with you when the medical utopia you are advocating comes crashing down. Remember – you get what you pay for.
Nightwing| 7.6.11 @ 12:46PM
Now, now Doc....just relax your sphincters a little bit, OK?
I wasn't suggesting you convert your office into a charity operation. Indeed, I recognize health services as a commodity, not a "right." So like all commodities ( including services) they have to be paid for.
Thanks for making my point that today's "system" is reimbursement driven.
And, as the former administrator of a multi-site, multi-million dollar operation I am well aware that government payments, particularly 'Caid are often well below cost. BUT, we accepted them anyway because the stated mission-purpose of the institution was to TAKE CARE OF PATIENTS. And, in the population mix, something was better than nothing.
"Remember -- you get what you pay for."
A nice cliche, and sadly untrue when it applies to health care in this country. There's no apparent correlation between dollars spent and quality delivered. It is often boasted that America has "The Best Healtcare System in the World."
The truth is, we have "The Most EXPENSIVE Healthcare System in the World."
Healthcare costs are on track to reach 20% of GDP soon, far more than any other nation. Yet life-expectancy in the USA ranks 37th in the world, barely on par with much less developed countries.
This trend is unsustainable and unaffordable, and Obamacare does little to change that. Mostly, all it does is open still more reimbursement channels.
Healthcare costs also impede the competitiveness of American products where they have to be figured into pricing formulas. Moving a plant to Canada, for example, eliminates that hurdle for employers.
For those who are upset with Obamacare now, if something is not done soon to reduce soaring medical costs in the USA, the future may bring something far worse----a total takeover of the system by government complete with price controls much like Canada.
What I'm saying is that if those of us who have worked hard in the profession don't take the initiative to guide public policy, we sure won't like the outcome forced on us by our failure.
Now, I don't call people names and sure don't think you're callous. But the time for "business as usual" is over, and fee-for-service is just about dead in this country or soon will be.
A utopian vision you said? Not hardly.
I'm saying it's time for the trillion dollar "Healthcare Industry" to stop viewing patients as financial fertilizer.
yisong| 10.28.11 @ 9:35PM
Three Row Roller Bearings are constructed with three independent rolls of rollers to handle a combination of axial, radial and overturning moment loads. http://www.1stbearing.com