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2009-08-20 Home Front: Politix

Another Phony Obamacare Doc Shows up at Bwany Fwank's Townhall

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Posted by Beavis 2009-08-20 00:00|| || Front Page|| [11127 views ] Top

#1 These must be the additional doctors we will need when Obamacare adds another 47 million patients.

Posted by Richard of Oregon 2009-08-20 01:43|| 2009-08-20 01:43|| Front Page Top

#2 You probably DO need to reform the AMA Guild in order to stop them artificially lowering supply of doctors to raise wages.

Posted by Bright Pebbles 2009-08-20 08:22|| 2009-08-20 08:22|| Front Page Top

#3 The supply of doctors has been lowered for years by limiting the number of Americans accepted into med school. The gap has been filled with H1B visas, especially in rural areas. They accept Medicare patients, with lower than cost reimbursements, when others won't.

Posted by Lumpy Elmoluck5091 2009-08-20 08:53|| 2009-08-20 08:53|| Front Page Top

#4 Lumpy has it right.

The US has 131 medical schools and a 25 osteopathic schools. They get some capitation money from the feds. The feds haven't been giving more, the state legislatures haven't been putting more money into the public schools, and the private schools are stretched.

It's not just money -- you also need a certain number and size of hospitals, etc to train the students, and a city, even a major city, only has so many of those. We have six medical schools in Chicago and we couldn't fit a seventh in.

So we graduate ~ 16K docs a year and can't increase that easily.

So we import ~ 5-6K international medical grads (IMGs) a year to meet demand. That number is going to go up over time but it's also limited by the total number of graduate medical (residency) training slots that are available. That's ~ 22K a year right now, and capped by -- you guessed it -- the Feds, who pay capitation money to the training programs under Medicare Part A.

The IMGs do take practice positions that American grads generally won't take, and that's why you see them more in rural and inner-city practice situations. When your choice is Detroit or Peshawar, it's an easy decision.

Posted by Steve White 2009-08-20 09:40|| 2009-08-20 09:40|| Front Page Top

#5 Don't forget the absolutely exorbitant insurance coverage medical professionals must pay to protect themselves from "malpratice" lawsuits. Crooked lawyers and our 'win the lawsuit lotto' collective greed is doing us in and deservedly so!

Posted by Besoeker 2009-08-20 09:47|| 2009-08-20 09:47|| Front Page Top

#6 Reading the Gateway Pundit comments is a real hoot, btw. Realtor Sheila Leavitt, known for her liberal bumperstickers wnd Support the Iraq Oppisition posters, must have been brain damaged when a redneck trucker rear-ended her at the toll booth.

Posted by Lumpy Elmoluck5091 2009-08-20 09:47|| 2009-08-20 09:47|| Front Page Top

#7 My bad. Should be 'and' & 'opposition'.

Posted by Lumpy Elmoluck5091 2009-08-20 09:50|| 2009-08-20 09:50|| Front Page Top

#8 During the Vietnam War, DoD had an interest in getting doctors. So, it got funding and built a medical school to train docs and nurses. That's when the AMA stepped in and through political muscle stipulated you can have it, but 'we' will never accredit those who graduate. They viewed it as a threat to their income which had seen a major increase since the end of WWII. You know - supply and demand. End of program. Just another agent in the cost of medical care that generated this issue.

Posted by Procopius2k 2009-08-20 10:16|| 2009-08-20 10:16|| Front Page Top

#9 This is one idea that Fidel Castro had that paid off in spades. That is, *anybody* in Cuba can go to specifically medical school. And of course the vast majority of the doctors produced are mediocre, but that's the rub--most of what doctors *do* is mediocre.

So Cuba has so many doctors, that it actually makes a fortune by exporting them. Countries (and even rural areas in the US) with a severe doctor shortage are far happier to have mediocre doctors than none at all.

The zinger is that even before Castro, Cuba had a much higher per capita number of doctors than usual. Even Americans went there to get their MD when American schools wouldn't let them in, even though they were capable students.

Importantly, while the AMA is the largest doctor organization, it is not the only one. There are 26 major ones in the US, and several are "general" associations like the AMA.

Posted by Anonymoose 2009-08-20 10:38|| 2009-08-20 10:38|| Front Page Top

#10 Did she at least stay at a Holiday Inn Express the night before?

Posted by CrazyFool 2009-08-20 11:21|| 2009-08-20 11:21|| Front Page Top

#11 Perhaps Dr. White could add some info about how doctors' incomes, as a result of the artificial supply squeeze, have risen commensurate with the cost of insurance. Oh, wait ....

Well then, perhaps the insurance industry's profits must have risen commensurate with the meteoric increase in medical .... oh, wait ...

I think ATLA (the ambulance chasers' outfit down in Georgetown) might know if THEIR membership has seen revenues increasing above the rate seen elsewhere in the economy - surely a "yes". Just one part of the puzzle.

Costs for non-insured medical care (elective plastic surgery, non-ag veterinary) have held steady or even declined recently; a few firms like Safeway that instituted head-smackingly obvious common sense provisions like out-of-pocket-then-reimbursement for most medical events combined with self-insurance have seen costs level off or drop.

Costs have zoomed becasue they CAN; they CAN because of the de facto subsidy of almost all medical "care" (tax system, corporate taxes, company connection only due to arbitrary WWII policy, and other things). When prices aren't allowed to rise - through reconnecting cost and service, as it is in all other areas of life, and eliminating all the subsidies inherent in the system - then cost increases will probably resemble those in other sectors. Not before.

Our medical care is far and away the best of any large country; its financial organization is insane and unsustainable, mostly for the usual reasons: subsidies (disconnect between cost and service) and lack of competition.

Posted by Verlaine">Verlaine 2009-08-20 12:11|| 2009-08-20 12:11|| Front Page Top

#12 The limiting factor for physician supply is not medical schools but postgraduate training. The financial incentives to set prices for care are truly counterproductive. However, I have read that even if all US physicians' fees for service are not the largest part of all US health care expenditures. That part is: record-keeping and reporting.

Posted by Anguper Hupomosing9418 2009-08-20 12:35|| 2009-08-20 12:35|| Front Page Top

#13 Anguper: we have more GME positions than we have medical school positions. We fill the balance of GME positions with IMGs. If we increase med school enrollments we'd need fewer IMGs. Or if we increase residency positions but not med school, then we need more IMGs.

The limiting factor for physician supply then is 1) med school seats 2) GME seats and 3) IMG supply.

Posted by Steve White 2009-08-20 15:43|| 2009-08-20 15:43|| Front Page Top

23:35 CrazyFool
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23:22 Pappy
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22:38 Barbara Skolaut
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18:54 Besoeker