Wednesday, April 16, 2014

My turn: It’s hard out there for a doctor

From page A4 | October 09, 2013 | 16 Comments

America’s doctor shortage is quickly becoming a crisis. No less than 14 states have introduced legislation or created new programs to deal with the problem.

The Association of American Medical Colleges reports that the country is currently short 20,000 doctors. Over the next decade, that number could quintuple.

And Obamacare is only making things worse. Physicians are responding to the health reform law’s intrusive regulations and insufficient payments by treating fewer patients — or even abandoning the medical profession altogether.

One cornerstone of Obamacare is its expansion of Medicaid, the jointly run federal-state health insurance program for the poor.

Starting in 2014, the program will cover all Americans with incomes up to 133 percent of the federal poverty level. The federal government will absorb 100 percent of the cost of this expansion through 2016, and then a declining share in subsequent years, until the feds’ responsibility rests at 90 percent in 2020. By then, some 12 million people will have gained coverage anew through Medicaid.

But the program is already dysfunctional. Reimbursement rates are so low — about 60 percent of the rate paid by private insurers — that doctors routinely refuse to see Medicaid patients. A recent study published in Health Affairs found that 33 percent of doctors did not accept new Medicaid patients in 2010 and 2011.

By throwing millions more people into the program without raising Medicaid payment rates, Obamacare will make it even harder for patients covered by the program to secure care.

The story is much the same for the government’s other big health program — Medicare. More than 9,500 doctors opted out of treating Medicare patients in 2012. That’s almost triple the number that abandoned Medicare in 2009.

According to American Medical Association President Dr. Ardis Hoven, “While Medicare physician payment rates have remained flat since 2001, practice costs have increased by more than 20 percent due to inflation, leaving physicians with a huge gap between what Medicare pays and what it costs to care for seniors.”

Unsurprisingly, Obamacare will exacerbate the problem. The law creates a new government entity — the Independent Payment Advisory Board (IPAB) — charged with ensuring that Medicare hits designated spending targets. IPAB is forbidden from rationing care or changing seniors’ benefits. So the Board’s only real cost-cutting option will be to ratchet down reimbursement rates for doctors.

Obamacare will also reduce payments to doctors who do not adhere to the law’s byzantine new regulations. For instance, doctors who fail to comply with the Centers for Medicare and Medicaid Services’ Physician Quality Reporting System or order a certain number of prescriptions electronically could see their reimbursements docked up to 7 percent by 2017.

In many cases, doctors will have to make substantial investments in their office infrastructure and computer systems just to follow all the new rules.

Many doctors — particularly those nearing the end of their careers — will simply hang up their scrubs instead of spending heavily to comply with Obamacare. According to Dr. Jeff Cain, President of the American Academy of Family Physicians, “Almost a third of family doctors in rural America are thinking about retiring in the next five years.”

A 2013 Deloitte survey of physicians found that six in 10 doctors believe that many in their profession “will retire earlier than planned in the next one to three years.”

Those who can’t afford to retire may look to partner with hospitals in order to offload increases in overhead fueled by Obamacare. That’s bad news for physicians, hospitals and patients alike.

American Enterprise Institute Senior Fellow Dr. Scott Gottlieb predicts that doctors will work less, once they become salaried employees of hospitals. Their employers will respond by reducing their pay. And patients will find that they’re competing for an ever-scarcer number of appointments.

Obamacare is causing a doctor depression. And what’s bad for doctors is ultimately bad for patients. The cure for this sickness is full repeal of Obamacare — and the installation of market-based reforms in its place.

Sally C. Pipes is president, CEO, and Taube Fellow in Health Care Studies at the Pacific Research Institute. Her latest book is The Cure for Obamacare (Encounter 2013).


Discussion | 16 comments

  • Jennifer GrayOctober 09, 2013 - 10:47 am

    Having been a foster parent last year; I witnessed firsthand what the “Medi-Cal” debacle is causing. (we lived in Yuba City at the time) We fostered two really great kids for about a year; and with them came along Medi-Cal cards. This was my first exposure to the state’s low income insurance program and I was quite shocked at how poor the level of care is and how hard it was to find care for these children. I could not just take them to the same pediatrician that my own children visited through Sutter North (they no longer accept Medi-Cal at all); I had to seek out a Dr. that would accept Medi-Cal. After 2 days of calling pediatricians through the phone book; I had to resort to calling the public health nurse to get a list of providers….it turns out that ONLY the low income clinics in Yuba City were accepting Medi-cal. The low income clinics took forever to get appointments with, the kids never saw the same doctor (though usually it was a nurse practitioner), all of the signage and posters were in Spanish or Punjabi (apparently no one who speaks English goes to the low income clinics). They cancelled appointments and did not reset them (without giving a reason); the wait time even if you had an appointment was hours…and then you had to fight to get medi-cal to approve the prescription that the Dr. would write. The whole medi-cal experience was an overcrowded/poorly run nightmare…and I kept thinking…they want to throw more people into this mess and lie to them saying they are getting “quality health care”. It really is going to be a mess; and the idiots who are trying to push this mess through should be FORCED to use the same level of health care they are gifting to the “poor”…then perhaps they could see the errors in their thought process.

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  • JEDOctober 09, 2013 - 1:13 pm

    What's Going Wrong at the Pacific Research Institute? By publiusforum, August 7, 2012 at 1:59 pm -By Warner Todd Huston Early in July extreme left-wing Mother Jones magazine published a piece claiming that Sally Pipes, the head of the Pacific Research Institute, was not doing a very effective job of leading the San Francisco-based conservative, free-market think tank. Unfortunately, whether the magazine is left-wing or not and whether these questions make me comfortable or not (they don’t), there seems to be some truth in the story. The magazine focused on the excessive amount of money that Pipes has requisitioned from the think tank to pay for Public Relations agencies to assist her in writing the many books, papers, articles and the like that carries Pipes’ name. Calling her "supernaturally prolific," Mother Jones reported that Pipes employs Keybridge Communications to do the writing. In fact, according to Mother Jones, Pipes has spent "nearly $1 million -- $400,000 alone in 2010" on the services of Keybridge. This is a substantial amount of money considering that the institute has an annual budget of only $4 million. To have spent such a huge chunk on "research assistance" is quite a lot, indeed. Pipes has a very high profile in conservative circles. She is a sought after speaker with a specialty in healthcare. She's worked with such big name groups as the American Enterprise Institute and the Heritage Foundation, and her work appears in newspapers, magazines, and websites everywhere -- such as Forbes, the Wall Street Journal, and National Review. Pipes is also listed as the author of at least a half dozen books. Pipes is a naturalized American originally from Canada and made her first mark as the Assistant Director of the Fraser Institute, Vancouver, Canada. Using her familiarity with the Canadian healthcare system, Pipes became known in the U.S. for raising the clarion call warning America against socialist healthcare systems. As it happens, I find what Pipes has to say about healthcare valid. Once Obamacare became the central issue of the day, Pipes quickly became an authority speaking frequently on the subject. Reputation as an expert or no, it might be considered problematic if Pipes has the constant assistance of a ghostwriting agency, especially for the president of a think tank. After all, usually think tanks greatly value the academic work of their members. Consequently, unlike in politics, ghostwritten work is not standard or customary. Usually the denizens of think tanks are required to write their own stuff, for sure. Another one of the interesting issues is the fact that Pipes doesn't seem to have the think tank standard of education to "qualify" her for the position she holds, the papers she writes, or the testimony she's given before Congress. Her biographies never seem to mention much on the subject of her education. Certainly if what someone writes is demonstrably right, properly erudite, or academically logical, the education the speaker (or writer) may be immaterial, granted. And this over-reliance on some long list of degrees can also appear absurd. However, for think tanks at least, an advanced education is usually a prerequisite, not an option. Yet Pipes has attained this superior position seemingly without a lot of sheepskins to her credit. Good for her, I may say, but still this makes her an outlier in the world of think tanks. So, what is going on here? Are Mother Jones and other far left websites just being partisan? To some degree, yes. After all, what Pipes has to say about healthcare is in no way out of the ordinary for conservatives and it does seriously challenge the left’s positions on the subject. The fact is, Pipes is not in the least bit controversial on her chief subject for the free market side she represents. But what about her "supernaturally prolific" writing output? She does have a great deal of work attributed to her name, and more rolls out every month. With this the accusation that Pipes is using PR agencies or industry flacks to write her work, to which she just affixes her name, seems quite plausible. This, if absolutely true, would make her leadership of the PRI a shell game and a rather self-serving one, too. I made some calls and sent some emails to see what I could find out. I was able to get a lot of feedback, but only on background. It might be easy to dismiss Mother Jones' piece based as it is on unnamed "former PRI staffers." But as I tried to look into this story myself, I quickly found out that no one wanted to go on the record. Internal mud slinging is, in the sophisticated and educated think tank world, a taboo. I also looked around online. While there wasn't much to find there, one thing I found was a video of Pipes that was made just before the Supreme Court's recent Obamacare decision. The most remarkable thing about the video is that Pipes allowed herself to be called "Doctor Pipes" during the entire interview. But as noted above, and in the Mother Jones article, it doesn't appear that Sally Pipes has any advanced college degree that would afford her the title of "doctor." Oddly however, she never corrected the interviewer, a media figure she has been acquainted with for many years. It was the off-record communications I had with folks close to the institute that really raised my eyebrow. The primary complaint I heard was that Pipes uses PRI as her personal and principal means of self-promotion, but leaves few resources to further the work of the other acclaimed scholars and researchers of the Institute. One source told me that a PRI’s researcher had to fight Pipes tooth and nail for even a small amount of money to help him purchase advertising for his work, even as Pipes routinely spends thousands of dollars of PRI's earmarked funds to advertise her own work. It seems that Pipes sucks up all of the institute's funds for her own personal promotion, leaving little else for the scholars and researchers at the think tank, despite any funding allocated for their specific projects. Another person attached to PRI warned me that Pipes routinely inflates the marketing costs for her work. I am told that if someone can acquire her proposals to the board, one would soon find the sum of $25,000 constantly quoted for marketing. This source also says that $25,000 is an extremely high quote for that purpose. In any case, I understand that the issues raised here appear unverifiable. But, it appears to me that there are some troubling questions that need deeper investigation by responsible people, and maybe even think tank donors. It appears that the Pacific Research Institute is being held back by Pipes, that other scholars and researchers of the institute are being unfairly pushed to the background in order to flog Pipes' work and inflate her persona, and that some top notch, important free market research is being lost because of one vainglorious individual. It seems to me that the Pacific Research Institute is being misled and wasted under the leadership of Sally Pipes.

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  • JEDOctober 09, 2013 - 1:16 pm

    Basically the "think tank" Sally works for is there to promote her extreme conservative ideology and to then distribute their distorted untruths to local media such as this. Go to which is non-partisan for your facts. Sally has an agenda to promote.

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  • EvelynOctober 09, 2013 - 1:26 pm

    JED: (1) I hate 1,900 word entries and generally won't read past word 1,899. (2) Where do you get your confidence in's neutrality?

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  • Truth, nothing but the truthOctober 09, 2013 - 1:33 pm

    Evelyn, where do you go to find "the facts" that you are comfortable with? Do you have neutral ways of finding the truth even if it doesn't fit your picture of how things should be?

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  • EvelynOctober 09, 2013 - 1:38 pm

    In the past 3 years has received $2.4 million from the Annenberg Foundation, BY FAR their most significant donor. HERE

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  • EvelynOctober 09, 2013 - 1:45 pm

    Truth: My picture of how things "should" be differs vastly from how things actually ARE. Commonly, I post article titles and/or short excerpts, including source links. People can (and do!) decide for themselves on the merit, or otherwise. If what you're saying is that much of what we read is opinion, then I totally agree. But opinion and information are different creatures. Distinguishing between the two is a hard -- and interesting -- slog.

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  • EvelynOctober 09, 2013 - 1:49 pm

    P.S. Arriving at "the truth" is an unending journey frequently requiring us to change direction upon receipt of new input. We never fully "arrive", but we can come closer.

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  • Truth, nothing but the truthOctober 09, 2013 - 4:14 pm

    Evelyn, Yes, much of what we read is "in fact" the author's opinion and yes, with new information that opinion can, and many times for truth's sake, change. Yet, sometimes black is black and white is white. I have never experienced, but now I will check it out for curiosity sake.

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  • cookie65October 10, 2013 - 5:57 am

    obozocare was written by people who exposed their core beliefs within the law, they couldn't help themselves. The results being more IRS agents and less doctors. It ain't about healthcare. Leftists have a psychological need to rule over others. It is all about them, and nothing else.

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  • EvelynOctober 10, 2013 - 8:15 am

    JED: If you're still around, tell us which of Sally Pipes' statements you or find to be untrue. Though posting a lengthy article assailing the Pacific Research Institute, you've given no indication what in the Pipes article doesn't check out.

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  • EvelynOctober 10, 2013 - 8:29 am

    HERE is JED's October 09, 2013 - 1:13 pm article: "What's Going Wrong at the Pacific Research Institute?" Having just now spotted this: "As it happens, I find what Pipes has to say about healthcare valid" I may go back and read those 1,900 words!!! Thanks, JED.

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  • Jeffrey ScottOctober 10, 2013 - 2:43 pm

    Have you ever noticed that when you use a ridiculously childish name for someone you don't like (obozo, obummer, B.Hussein O,) or when you blame one political party for EVERYTHING from a crack in the sidewalk to a meteor shower, people generally ignore you and, after an eye roll and a little snicker, move on about their day?

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  • cookie65October 10, 2013 - 5:21 pm

    Jeffery Scott, thanks to you I have noticed it. The dems referring to the repubs as terrorist, anarchists, arsonists, racists, bigots, suicide bombers, the list is long. And I can't remember anything that hasn't been the repubs fault since 2000. And don't even get me started on the colorful language they use to describe the teaparty.

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  • Jeffrey ScottOctober 11, 2013 - 9:26 am

    So, you're saying it's OK because the other side is doing the same thing? That's kind of childish, isn't it? How about rising above the bar and making your responses more mature? That way, you don't sound like a broken record. You know what people do with a broken record, don't you? They disregard it and throw it away.

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  • EvelynOctober 12, 2013 - 8:59 am

    Ben Carson: "Obamacare is the worst thing that has happened in this nation since slavery. It is making all of us subservient to the government. It was never about healthcare but about control." - HERE

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