Monday, June 15, 2009

National Health Insurance: Are Doctors Insane?

Every so often I see a poll that amazes me... but probably shouldn't. Today's poll was from a University of Indiana professor cited in a news article stating that 59 percent of doctors favor government legislation to establish national health insurance.

I am constantly amazed by the lack of ability for smart people to think 2, 3, or 4 steps ahead in terms of the impact a given policy is likely to have on them and on their profession generally. For doctors, the impact of a nationalized health plan that Obama is taking the first small step towards will mean even lower payments and reimbursements and will result in them providing even less personal care to their patients. Doctors offices will become even more like restaurants where the goal is to get'em in and get'em out as soon as possible to make as much money as possible given the constraints of this new system. It's already somewhat bad. This will make that even worse.

I don't seem to think doctors recognize that when Obama talks about cutting costs he means cutting payments to hospitals, and cutting medicare and medicaid reimbursements, and ultimately to the doctors. He can and has said that he is not going to cut payments to doctors, but, again thinking a few steps ahead, how can hospital payments be reduced and medicare reimbursements be reduced and yet doctors remain unaffected? Now you might say that doctors make too much anyway so who cares? But when the doctors themselves don't see where this is going, it's a bit surprising. Doctors are altruistic in differing degrees. Maybe some see themselves as noble souls who don't care about a reasonably high paycheck even after all the effort expended to earn the title of doctor. But undoubtedly this will affect many, if not all, who will give up dealing with a new government bureaucracy and just enter into a specialized cash-for-service practices outside the system. This will also probably reduce the number of hihgly qualified doctors in the long-term. This will have a negative impact especially in rural areas. The way around this is to open up medical schools to more students who are less qualified. This may not be a great idea.

Overall, there are free market alternatives. It's not reasonable to believe that the government is the only serious option in tackling the almost 50M people who are uninsured. I will say that Republicans deserve a lot of blame for not seriously addressing this when they were in power. This reinforces the lesson that to fail to use your authority in beneficial ways when you have the opportunity is a tragedy and a failure that we all pay for. We are about to begin to pay for it now that the naive and idealistic kiddies are back in charge. Once we start going down this road it's hard to turn it back. The notion that government is going to be a competitor and that this will actually increase health insurance competition is completely absurd. For more info on that line of argument:

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