Marshall Ackerman, who's been a doctor since 1969 in the D.C. metro area, doesn't much appreciate the characterization of doctors during the health care debate. Click through to read the whole thing for the full extent of Obama's, shall we say, "misinformation" about physicians.
But that's not why Ackerman is anti-Obamacare. He charts his first-hand experience with the changes Medicare brought to his profession and wonders what further government involvement will do to the men and women we depend on to treat the rest of us:
I have been a practicing orthopedic surgeon for 40 years. I have observed profound changes in my profession since the advent of Medicare, changes that have affected patients' access to care. As reimbursements plummeted, internists abandoned hospital care to the new specialty of hospitalists, created boutique practices and stopped participating with health insurance companies. Physicians in all specialties have been retiring at earlier ages than ever before....
Consider the implications when a global fee will be paid to the hospital: Then hospital and physician incentives will be aligned, and patients will bear the cost of the search for ever-cheaper implants and techniques, such as a return to cemented total hips. Forget metal-on-metal bearings, resurfacing, rotating platforms, high-flex knees, navigation systems or bilateral replacements. And if our hospitals are financially penalized for occurrences such as infection and deep-vein thrombosis after surgery, who will operate on the obese, the hypertensive or the diabetics among us? Experience with government funding reveals a never-ending spiral of decreased reimbursements in the name of restraining costs. In the end, this will come out of the care we all receive.
The effects of government intervention with price controls is something liberals don't address well. Being a doctor is a complex job that requires many years of very expensive training, and extremely expensive malpractice insurance. Making a decent living after those years of schooling is what makes the profession attractive enough to bring some of America's best and brightest to it. When government uses its "negotiating power" to bring down the cost of medical care by artificially setting prices below what the market can sustain, the system will lose doctors. They deserve a reward for their efforts- beyond the great honor of having their motives impugned by the president of the United States in a health care speech, of course.
The men and women who treat us every day do not have to be doctors, as anesthesiologist Ronald Dworkin notes in today's WSJ:
The progressives' third mistake is to skimp on anesthesiology. In no medical specialty is the spread between the Medicare rates and private insurance rates greater. Progressives expect to pay anesthesiologists Medicare rates, which are 65% less than private insurance rates, without any change in the system. But there will be changes.
Some anesthesiologists will leave the field. They are already faced with lawsuits at every turn. Something else has happened in America that threatens to tip the balance for anesthesiologists. Americans have grown very fat. This complicates anesthesia tremendously. Putting in IVs, spinals and epidurals is harder. Inserting breathing tubes is much more dangerous.
Doctors are largely very smart, driven professionals who could become successful entrepreneurs, ad men, consultants, or (gasp!) lobbyists. You name it. Liberals will kvetch that doctors aren't or shouldn't be in it for the money. Indeed, many of them aren't, and spend much of their spare time helping the poor with overseas medical missions, inner-city dental check-ups, and free clinics. But they do and should act in their own self-interest.
When dealing with low reimbursement rates and government mandates becomes "unsustainable," as liberals might put it, they will leave the profession, retire early, and start clinics that do reward them for their hard work.
I have a friend who's a Georgetown med student. He studies and works almost non-stop to stay in school and treat patients. He sincerely wants to help people by doing something he loves, but there should be a reward for his work that matches the effort he expended. There's a reason doctors get paid more than, say, the average journalist. They work harder to get there, they take on greater risks and greater costs, and their talents are arguably more scarce.
Which is why, in the Netherlands, the government had to give up much of its health care power when their government-run system began to hemorrhage doctors and service. Stanley Goldfarb (yet another doctor) points out the Netherland government's line on this change:
In the 1980s, it became clear that the Dutch health care system lacked incentives. On the supply side, the government was heavily involved in determining the price and volume of delivered health care services. This made the health care system both inflexible and fragmented. Diverse and separate funding systems prevented substitution of cheaper outpatient care for expensive institutional care. The government set spending ceilings for each part of the health care sector. Service capacity and prices were regulated centrally...
Under the Health Insurance Act of 2006, the sickness insurance funds were abolished and Dutch citizens were required to purchase their health insurance from profit-making private health insurers, which prior to 2006 insured only the wealthiest third of the population. Private health insurers negotiate on behalf of their members with care providers such as hospitals, general practitioners and pharmacies the scale, quality and price of services charged their members. Consequently, the health insurers play a pivotal role in implementing the Health Insurance Act. Insured persons can now 'vote with their feet'. They may change their health insurer once a year if the premium is too high, or the quality of care, bought on their behalf, is too low. This incentivizes both health care providers and health insurers to be efficient in the delivery (providers) and purchase (insurers) of health care.
Young liberals, screaming for single-payer while they're on backpacking trips in search of the elusive "self" none of them can seem to find in under 5 years, would do well to remember that there are folks out there for whom following their heart songs must yield a decent living. That is, if they actually want a doctor to treat them for dengue fever, or whatever else they contracted hiking in Honduras.