Comments on the Myth of the World-Class Cuban Medical System

Michael Moore in Sicko, Jimmy Carter, Obama, and CNN, PBS, and ABC News reporters have all praised the Cuban medical system as one of the best in the world.  Most recently, Representative Keith Ellison, also Deputy Chair of the Democratic National Committee, has made the same claim. An article by Humberto Fontova addresses these evaluations of the Cuban Medical System with some interesting observations.

In summary of the most interesting of these:

• According to the Association of American Physicians and Surgeons, more than 75% of doctors with Cuban medical degrees cannot pass the U.S. licensing exam given by the Educational Commission for Foreign Medical Graduates
• Most Cuba-certified cannot pass the Educational Commission for Foreign Medical Graduates exam for certification as physician assistants
• In 1958 before Cuba became a Communist regime, Cuba ranked 13th in the world in infant mortality.  Now, it is 43rd in the world, based on massive fraud in its reporting of infant mortality.  41.5% of pregnancies are ended with abortions, because any indication of a troubled birth results in an abortion, in order to keep the infant mortality rate low.  In addition, Cuban "doctors" are pressured to report the deaths of children younger than 1 year old as that of a child older than 1 year old.
• As in all Communist nations, the finer medical facilities so often pictured in propaganda reporting are not available to most people.

With all the calls for single-payer, a means of avoiding saying government-controlled, medical systems, we should remember every instance of incompetence or downright malignancy in examples of government-controlled medical systems.

Government Continues to Lower Expectations for Pre-paid Health Care Exchanges

The federal government pre-paid medical care exchanges are supposed to be working better today.  They are supposed to handle up to 50,000 people on-line at one time now.  Since the federal exchanges are claiming you can sign-up for plans beginning on 1 January 2014 until 23 December, this means that counting today, there are 23 days to sign-up.  So far in two months, it is thought that about 150,000 have chosen plans.  At 50,000 sign-ups per day henceforth a grand upper limit total of another 1,150,000 sign-ups may occur before time has run out.  Some people will not sign-up for anything until they have been on-line over the course of several days examining the offerings and then looking into the provider networks elsewhere.  The enthusiastically socialist state of Maryland, which operates its own exchange, has a much earlier sign-up deadline of 10 December and a very confusing website.

It is not at all clear that even if one signs up by 23 December on the federally operated exchanges, that one will have an actual plan by 1 January 2014.  This is because you do not have a plan until you have paid the company offering the mandated ObamaCare pre-paid medical care plans.  The federal exchanges do not yet have a means to enable such payments.  Given their track record to-date and the methods they are using to manage the exchanges still, it seems unlikely they will have a working mechanism for making payments to the plan providers before Christmas.  So, it seems very certain that fewer than 1,300,000 plans will actually exist on 1 January 2015.

Recall that ObamaCare was passed so that 47 million Americans without health insurance would have pre-paid medical care once it was implemented.  Nothing was said about many millions of people who had insurance losing that insurance.  As it happens, to-date more than 5.55 million insurance plans have been cancelled and the federal government wants to declare success for ObamaCare if 1.3 million new plans are issued under it.  But, this is a net loss of 4.25 million insurance plans, while the supposed 47 million Americans uninsured before will all remain uninsured.  Yes, of course some of them will get ObamaCare insurance and more than 4.25 million of the newly cancelled plans will have no replacement.  The few state-run exchanges which work better than the federal government exchanges will manage to sign-up a few more of the 4.25 million lost plans, but will not sign up most of them either.

Meanwhile, throughout 2015, tens of millions more health insurance plans offered by small businesses and big businesses will be cancelled or replaced by more expensive plans with much increased employee contributions.

On 1 January 2014, many more Americans will have no health insurance and no pre-paid ObamaCare medical care than the original 47 million claimed uninsured who were the very justification for the wrenching changes to our medical care system including the loss of our doctors and hospitals, especially the better ones, the cost of much increased premiums for most of us, the increase in deductibles for most of us, the need to travel much greater distances to the health care providers for many of us, long waits to see doctors or nurse and pharmacist substitutes, a decrease in medical innovation, a decrease in covered medical procedures, more trips to medical facilities to get through a given medical procedure, decreased medical and financial privacy and security, and the many aggravations of having to choose and learn new health networks and how to do their increased paperwork.

Socialized Medicine and a Doctor's Moral Obligation

A friend asked this question:

One of the arguments I have heard from proponents of socialized medicine is that it is immoral to stand by while someone dies, and therefore society is obligated to help when someone is facing a life threatening illness but can't afford the treatment. Although there is much to refute in this type of statement, I am wondering about the more difficult refutation. As a personal decision of each doctor, is it rational to make the decision to deny treatment based upon the fact of a patient's inability to pay?

The moral argument against socialized medicine, or ObamaCare in particular, is based on our equal, sovereign individual rights. It is not dependent upon whether a particular doctor decides that he must act to save a life independent of remuneration or not. It is an important moral principle that he is free to either be benevolent or not be benevolent. Now, I do believe benevolence is an important virtue, but benevolence is virtuous in the context that the person helped has value to the doctor.  Benevolence is not about self-sacrifice, since that would hardly be benevolent to oneself. 

If the person has an entitlement mentality, then the doctor generally has no rational reason to help that person without remuneration. It is perfectly moral for him to walk away. In the context of a society of largely productive and benevolent people, a doctor may be rationally inclined to provide help to those who cannot afford to pay for their care, especially if they have become ill or hurt through no great fault of their own. But, even that depends on context, such as the expense the doctor will have in helping him and whether his helping the unfortunate person means that he is not able to help someone else who can pay. He is not obliged to save the poor man, while letting the financially prepared man die! If he gives too much of his time to helping the poor, he may not be able to generate enough income to buy the medical equipment that will enable him to save many lives in the future or he may simply go out of business. The doctor must make difficult moral decisions based on a very complex context. Some may appear to make a greater effort in benevolent acts than others, but still may not be saving the most lives possible.

Rational men are going to balance these difficult decisions differently and we should be careful in our appraisals of their morality.  A doctor may be willing to give his services free in a given case, but he may be unable to convince a nurse and other assistants to give their time free.  Or the hospital may be unwilling to make an operating room available.  Now the proponent of socialized medicine will want to use force to make all of these needed experts and facilities available, but this is a violation of everyone's rights and cannot be tolerated in a civilized society.

My grandfather was a physician in the Great Depression. He was a surgeon who operated in the Mayo Clinic and all of the hospitals of Minneapolis and St. Paul. He did a very unusual number of operations on people who could not pay for them. But, people were different back then. A farmer might not have any money, but he would give Harry Christianson a chicken, which to the farmer was his fortune. Then very likely for 20 years after, when he could, he would stop by grandpa's home and leave a bag of potatoes or a bushel of corn. This was very welcome when rationing was going on in WWII for instance. Harry and his wife Bess always had free food and there was so much that Bess and her daughter Betty organized ways to get it into the hands of those in need in the city. One man decided he would paint grandpa's house in payment for an operation, but while he was painting the upper part of the exterior, union thugs knocked him off the ladder and shattered his leg. The man was not a union painter. He was just a farmer who wanted to pay a debt he believed he had. Harry and Bess put him up in one of their rooms until he was healed. The union later burned down their home because they did this.

So this is another important issue of context. There is value in helping people who put value on the help they receive. There is value in helping people who fundamentally believe that one should trade values for value.

There is little value in helping the ungrateful, however. Any deserving person, any person whose welfare one has reason to care about, will recognize the value they have received and will not presume that they have the rights of a master, while the doctor who worked so hard to develop his healing skills and knowledge is treated as his slave.  A doctor or any other service provider has the right to choose his own values and to pursue his own happiness in terms of his values.

The need of a poor person does not deprive him of this equal individual right to pursue his happiness.  Every man, whether poor or rich, whether a professional or a low-skilled worker, has this magnificent right to pursue his happiness.  No one has the right to dictate the values or the moral code which will define what his happiness will be.  All that can be required of another is that they are not allowed to initiate the use of force as a means to pursue their happiness.

This is very adequate for each of us when we exercise our freedoms and act within the private sector of our society.  In the private sector we have a wealth of potential opportunities to cooperate with others whose values are sufficiently similar to ours or in some way complementary so that each of us can pursue our goals defined by our individually chosen values.  When our values are not approved of by others, they are free to choose not to associate with us.  This is the realm of the voluntary and is relished by those who want rich choices and who abhor being forced to bend to the will of others.

In contrast to this natural realm of freedom, we have the realm of the government.  The principal property of government is its monopoly on the use of force in a society.  Because a wise society seeks to minimize the use of force and seeks to maximize individual freedom of choice and association with others, such a society has a minimal government.  Such a limited and legitimate government uses force only for the purpose of protecting the equal, sovereign rights of the individual to life, liberty, and the pursuit of happiness.

When government attempts to do more, it must necessarily do violence to the rights of the individual as it imposes values and moral codes upon the People.  With this loss of freedom to choose one's values, one loses many of the freedoms to use one's own mind.  One loses the choice of one's own goals.  With the loss of one's own goals, one loses all hope.  It is no accident that unfree societies become depressed societies with large increases in drug use, excessive alcohol use, and increased numbers of suicides.  Big governments do much harm to individuals and are notable in the brutally of their violence against their people should any insist on exercising their sovereign rights.  We see the party of biggest government verging close to a desire to let loose the hounds of hell upon the Tea Party people for just this reason.  Over and over they have tried to label the Tea Party people who simply want to preserve some of their individual rights as terrorists and subversives.  This makes the brutal nature of unlimited government all the more clear in our time.

Many Doctors Do Not Want to Be Obama's Slaves

Grace-Marie Turner wrote a good summary of doctor's reaction to the onslaught of ObamaCare for The Orange County Register.  Here is a summary of her summary:

• 28% of seniors had trouble finding a primary care doctor in 2008 compared to 24% in 2007.
• Only 38% of primary care doctors in Texas will take a new Medicare patient.
• The Mayo Clinic has stopped taking Medicare patients at several locations.
• The postponed 21% cut in doctor payments, will now have to be 30% in January.
• The American Osteopathic Association says only 40% of doctors will be able to continue seeing Medicare patients after the cut occurs because they will lose money on each patient.
• ObamaCare requires a big investment in information technology.
• ObamaCare requires more paperwork and cookbook medicine, eliminating individual tailoring.
• A simple error can result in a $10,000 fine.
• 70 million Baby Boomers are about to go on Medicare.
• The American Association of Medical Colleges projects a 150,000 shortfall of doctors by 2025.
• Longer waits for treatment and more emergency room visits will result.
• There is no increase in the number of residencies to train more physicians.
• 13% of internists will not treat Medicare patients at all.
• A financial planner with many doctor clients says half of them want to retire in 2013, just before the worst of ObamaCare takes effect in 2014.

This is just as one would expect.  Why would highly educated and dedicated professionals submit to the Obama slavery?  Would you really want one of the physicians who would accept slavery to perform an operation on you?  I would much rather have a proud professional, so when the time comes, I will just have to scrape up the money to pay one of the doctors who will not take Medicare patients.  There just isn't a free lunch when it comes to quality medical care. 

Well, maybe there sometimes was when the doctor had the freedom to donate his services for people really in need, but now that everyone simply plans to take advantage of him with the ObamaCare thugs pointing a gun at him, it is not likely he will be feeling charitable.  All you proud and capable doctors have little choice but to refuse Medicare moocher patients.  Better to refuse them than to spit on them.

Of course, if we are not a nation of voting fools, we will so throw the rascals out of Congress and the White House that we can repeal the ObamaCare nightmare with all its intended slaves and moochers.

Doctors and the ObamaCare Shortage

The Medicus Firm, a national physician search firm based in Dallas and Atlanta, polled physicians about ObamaCare and its effects on them.  They reported the results in the New England Journal of Medicine.  Key results include:

• 62.7% of doctors believe health reform is needed, but want targeted and gradual legislation, not the massive ObamaCare bill.
• 46.3% of primary care physicians (family and internal medicine disciplines) believe ObamaCare will either force them out of practice or make them want to leave medicine.
• 72% of doctors believe a public option will have a negative impact on medical care.

According to the Health Resources and Services Administration of the Dept. of Health and Human Services, there were 306,100 primary care physicians in 2005 and there were 511,400 Non-Primary Care specialist physicians in 2005, for a total of 817,500.  ObamaCare will depend upon these physicians to deliver the increased medical care that ObamaCare is supposed to provide to 32,000,000 more people.  About 15,000,000 of these people are expected to be added to Medicaid, which is a program a great many physicians will not participate in now or will not accept new patients from that program.  Who does this tyrannical Democrat government think will provide these services?  Many physicians are already also declining Medicare patients, though that program has paid somewhat better than has the Medicaid program.  However, the scheduled cuts in Medicare payments even as more and more Baby Boomers will soon enter it and need more medical care must surely cause the Medicare program to shift even deeper into underpaying doctors for their services.  The huge deficit growth of the federal government must further push it to making still lower Medicare and Medicaid payments to doctors.  The terrible condition of many state governments will also decrease their ability to make their expected and required Medicaid payments.

The net result is obvious, unless you are a pig-headed, pie-in-the-sky, other-worldly Democrat!  Doctors are going to be very unhappy.  Probably more than they now think even, as the reality of these much lower payments set in, as the tangle of myriad federal agencies start giving the doctors incredible increases in paperwork and contradictory requirements, as the number of unhappy patients pile up in their waiting rooms, and as the reality of having even less time per patient than the already inadequate time now causes them to lose all confidence that they are able to do their work in a manner consistent with professional standards, they will become seriously depressed.

When their work comes to be the source of depression, many will leave the profession.  The claim that 46.3% primary care physicians will do so or will be unhappy should be taken very seriously.  Many physicians will retire early.  In fact, there is clear evidence that many have already been unhappy enough with the pre-Obama
Care medical profession that they have been retiring early already.  We can learn more by looking at the age distribution of physicians according to the Health Resources and Services Administration.

First, note that despite the growing population of the U.S. from 2000 to 2010, the number of physicians in the three younger of the five categories dropped.  This trend is expected to be the case in 2020 also.  The only age group of doctors with an increase from 2000 to 2010 is the 55 to 64 year old group.  These doctors are close enough to retirement age and probably largely well enough off, that they can readily retire if ObamaCare is passed later today, as it now appears it likely will be.  Many of these doctors will indeed retire early and that means they will not be practicing in the 65+ age category either in the near future.  Many of the doctors already in the 65+ age group will quite immediately.


Now let us look into the future to the 2010 projection.  Note that the projection is rather optimistically expecting the future number of physicians in the 55 - 64 age group to remain as high as it is now.  This would mean a larger fraction of those in the 45 - 54 age group will continue on into the next age group than did in the 2010 case.  Given the effects of ObamaCare, this will surely not be the case.  This number will drop considerably relative to the prediction here.  It will also be insane to believe that a larger fraction of doctors will continue to practice after age 65 than did in 2000 and 2010 after ObamaCare comes into play.

The bad news does not end here.  There is another contribution to decreasing services which we are facing even without ObamaCare, which is going to make ObamaCare much less supportable.  To quote the Health Resources and Services Administration:

Currently, one in four physicians is female, but two factors are contributing to a rise in female representation. First, during the past three decades the proportion of new medical graduates who are female has risen from 10 percent to close to 50 percent. Second, the growth in female representation is a relatively recent phenomenon, and it is predominantly male physicians who are nearing retirement age. Although one in three active male physicians is age 55 or older, only one in eight active female physicians is age 55 or older. Because work and retirement patterns differ systematically for male and female physicians, the increasing proportion of physicians who are female has profound implications for the overall supply of physician services. Female physicians are more likely than their male counterparts to choose non-surgical specialties and to spend fewer hours per year providing patient care. They are also less likely to work in rural areas, and they tend to retire slightly earlier.

So, the increasing shift to more female physicians was going to lead to a smaller supply of medical services in any case.  Now, ObamaCare will chase more doctors out of the profession on top of the smaller numbers of younger physicians already and the larger fraction of female physicians who will work shorter hours and retire earlier.  This smaller pool of available physician manhours will be deluged by much more demand from aging Baby Boomers and from the greater demand brought on by ObamaCare.  The consequence will be that the quality of health care must degrade rapidly.  It will also become much more expensive, or degrade still more rapidly.  The law of supply and demand can never be denied.

We were already staring severe problems in the face.  ObamaCare is clearly going to make those severe problems catastrophic problems.  It will not be long before we really will have to be pulling the plug on granny much earlier than we have in the past.  Obama lied about this again just yesterday.  A lot of Baby Boomers are soon going to be very expendable.  Severe health care rationing is coming.  It probably was coming to some extent anyway due to the Medicare and Medicaid programs and the Baby Boomer demand increase, but ObamaCare will have to make this much more severe.  This will not be because anyone really wants this, except Obama and the Emanuel brothers, but because the Democrats do not think anything through and do not care about the constraints of reality.  They are simply other-worldly people.

Changes for Doctors and Patients Under ObamaCare

The House bill 3200HR is one of the bills being folded together in some mysterious way in Congress.  The Senate has some Democrat Senators and Rahm Emanuel huddled behind closed and locked doors meshing together the Health Committee bill and the Finance Committee bill, which seems to have become 1500 pages long suddenly after the Finance Committee voted on a conceptual plan a bit under 300 pages long.  We do not know precisely what the ill-chosen provisions of the final passed bill will be, but the way everything is being rushed and so much is being hidden, we have to evaluate as much as we can from the available information, or we will be caught flat-footed when the final version is rushed blindly through Congress.

Here are a few provisions of HR 3200 we had best take note of:

• Doctors are in the public option unless they opt out.  There is no mechanism for opting out.  The Secretary of Health and Human Services will set up a mechanism someday and it may include penalties, fines, taxes, and who knows what other disincentives.  In effect, the plan is to make doctors slaves who may then have some onerous option to buy their freedom, their manumission.
• The paperwork required of doctors has been increasing rapidly over the last 15 years.  This bill will increase it much more, cutting down on patient time, attendance at seminars and on post-graduate education.  They will have to document all interactions with the many new federal bureaucracies to be set up, as well as the greatly expanded ones.  They will have to document all referrals, determine if there are fraud risks, and continually update quality assessments.  They will be bored to death!
  
• The expanded patient records will include copious financial records, medical data, mental health evaluations, and such things as any sexually transmitted infectious diseases.  This data will be available to huge numbers of medical people and to many bureaucrats.  Imagine what the Democrats will do with this information on a Republican running for public office?  Apparently, they will use such information on that Republican's entire family, if we can extrapolate from Sarah Palin's case.
• If patient's must be readmitted to a hospital after being released, there are fines.  Those with chronic diseases, the disabled, and the elderly are most likely to be readmitted.  Doctors and hospitals will become reluctant to treat such people because they inherently bring with them an increased likelihood of fines due to readmission.  There will be attempts to transfer such patients to other facilities.
• End-of-life counseling will be required as part of the regular medical practice.  The government will train and approve the counselors.  It will provide the films, brochures, and the data to be given to the patients.  It is expected that this advice will be for them to forgo more than ordinary medical treatments and play upon their guilt in being a burden.  The health czar, Ezekiel Emanuel, believes doctors are obsessed with the Hippocratic Oath.  He serves on an advisory panel for the Hastings Center which states that patients should reject ordinary and extraordinary care and accept death.
  

The Cloak of Invisibility Hiding the Socialist's Death Panels

The socialists want control of the American health care system and the consequent power to make us all their dependents, their children.  They will make any argument to the People which will provide them a path to take over our health care.  They have chosen the following primary arguments:

• Health care costs too much and it is costing more faster than the economy is growing.
• Some Americans do not have health insurance, but everyone ought to have it.
• People with pre-existing conditions cannot get affordable health insurance.

None of these arguments are actually good arguments when examined carefully and rationally.  But they do carry some weight with many voters.  They also influence the design of the health care policies put forth by our socialist government leadership.  I am going to primarily address the cost issue in this post.

Where do the greatest costs in our medical system occur?  It is not at the primary care level with general practitioners, internists, and family physicians.  The primary costs occur when people are really in terrible danger of dying.  They occur when someone has heart disease or cancer.  If you have heart disease, you turn to a specialist called a cardiologist.  If you have cancer, you call upon an oncologist.  These physicians are much more highly trained than primary care physicians and their malpractice insurance costs a lot more.  The equipment they use also costs a lot more.  So, surprise, surprise, their services cost more.  You, however, are willing to pay more, because your life is on the line.  Or, maybe it is your mother's or your wife's life on the line.

To the socialist who acquires life and death power over our lives, the only thing that matters is reducing costs, at least those costs on the government's books.  So, they are desperate to reduce the costs of Medicare, where most costs occur, because most people are never so likely to be desperately ill as they will be sometime after becoming 65 years old.  So, like Willie Sutton who robbed banks because that was where the money was, the socialist removes medical care for the very sick elderly to save money, because that is where the money is spent.

But, how do you do this politically without having the voters catch on?  After all, it cannot be good to be seen to pull the plug on the voter's granny or wife.  The socialist is up to the challenge.  Socialists have been dreaming about taking such power for 200 years and have done so in many countries.  They have thought about this problem.  The Wall Street Journal just did a Review & Outlook piece on this called The War on Specialists.

The Obama administration is using a regulation to shift Medicare payments from expensive specialists such as cardiologists and oncologists to primary care physicians.  The 2010 rules will reduce payments to cardiologists by 11% overall and reduce payments to oncologists by 19% overall.  They will increase payments to primary care physicians by 6 to 8%.  In general, doctors will still be paid less than market value since Medicare's price controls now pay only 0.83 times private care costs.

Echocardiogram or stress test payments will be cut by 42% and catheterization payments will be cut by 24%.  These are fundamental tools for the cardiologist.  These cuts will force many community and independent practices to shutdown, lay off staff, and make patients wait, says Jack Lewin, head of the American College of Cardiology.  These tests will be used less often as a result, so cardiologists will be making more and more guesses and uneducated guesses about heart disease problems.

The socialist administration thinks oncologists are doing too many MRIs and CT scans.  Payments for some diagnostic imaging techniques are being cut by 24%.  It used to be assumed the instruments were being used 50% of the time.  The administration is now asserting that they are used 90% of the time over a 12-hour day, or 10.8 hours.  This unrealistically high utilization rate is being used to justify reduced payments.  Similar reductions are being made in payments for the use of all expensive equipment.  Consequently, payments for anti-tumor radiation treatments are being decreased by as much as 44%. 

Max Baucus, chairman of the Senate Finance Committee, has an additional insidious way to cut costs in his "conceptual plan."  Medicare will be required to rank doctors on how much they cost the Medicare program.  Those costing the most, those in the upper 10%, will be forced to return 5% of all the payments they have received for the year.  This requirement will start in 2015.  The specialists will be the doctors in the upper 10% of costs billed to Medicare, so they will be hard hit by this requirement.  Remember, they are already being paid less than their market value, the administration's 2010 payment reductions will give them still less of market value, and then many of them will have to give 5% back.  This will function as a powerful further deterrent to specialist doctors using the full power of the tools at their disposal to diagnose and treat your disease.  The 5% of doctors being penalized each year will consist of a much larger percentage of the cardiologists and oncologists each year.  This provision is aimed directly at reducing the services of those doctors most involved in trying to save lives in deep danger.

Fewer physicians will choose to enter these specialties.  As the population of Baby Boomers greatly increases the incidence of heart disease and cancer, the specialists who treat these diseases will be reduced in number and will not be allowed or able to use the equipment that correctly diagnoses the deadly diseases and aids the cure. The expensive equipment will not be affordable given the lowered payments, so doctors will not invest in it.  No actual death panel is ever convened to consider granny's illness.  No need.  The decision has been made.  The specialists she needs and the equipment he will need if he still exists, will simply not be available.  The result:  Granny dies.  Or your wife dies.  Or your daughter dies.  Or you die.

And nobody notices.  The Cloak of Invisibility, neatly arrayed by socialist politicians and bureaucrats years before, has covered and hidden the fact that they were the death panel that pulled the highly skilled human resources and the ingenious equipment out from under granny years before.  In the process, they also halted most of the innovations that may have allowed you or your children to live longer than granny will have.  Is this really the medical care you want?

Think long and hard before you give your backing to this insidious socialist death panel lurking in the darkness.  These death dealers are bent on returning us to the Dark Ages of Medicine when magic incantations and mere guess work were offered up as medicine.  I hear that leaches are not very expensive, but we had better not tell the socialist politicians and bureaucrats about this potential cost savings.

Decreasing Number of Doctors with Increasing Health Care Demand

From 2003 to 2006, the number of doctors in the U.S. grew at a rate of 0.8% per year. That is an increase of 25,700 doctors per year. Meanwhile, the U.S. population grew at a rate of 1% per year. Patients are increasing at rates faster than doctors.

The Obama/Democrat Congress health care reform effort intends to increase the demand still further for doctors by inducing people without health insurance now to acquire it and use it. They also envision a major increase in such services as preventive care, which they claim will reduce overall medical expenses and therefore the use of doctor time. Medical studies show that preventive care actually costs more and uses more doctor time, however. In addition, the mandated insurance plans will require expanded coverage for many medical services, increasing still further the need for doctors and other medical service providers' services. Despite the inevitable increase in doctor and medical service provider services generally, Obama and henchmen claim that medical costs will come down. Hogwash. Obama and his anti-reality gang of socialist thugs cannot control the effects of supply and demand. They can take actions to increase demand and to decrease the supply with respect to doctors, however.

The U.S. already has only 2.4 doctors per 1,000 population. The median in the OECD nations is 3.1 doctors per 1,000. The Association of American Medical Colleges found that enrollment in medical schools has decreased steadily since 1980. With current health care demand, they found that there would be a 159,000 doctor shortage by 2025. This shortage is already the result of the very unpleasant environment in which doctors have to work with skyrocketing malpractice insurance costs, less than adequate Medicare and Medicaid reimbursement rates, and arbitrary second-guessing of physician decisions by government bureaucrats for Medicare, Medicaid, and other government health programs.

The Medicare Payment Advisory Commission says that the number of elderly Medicare patients who had trouble getting a primary care doctor to take them increased from 11% to 17% from 2004 to 2007. ObamaCare will greatly increase the present aggravations of having to deal with government as it gradually takes over the half of the industry it does not yet control.

Investor's Business Daily (IBD) polled 1,376 doctors to see what they thought of ObamaCare. 65% said they opposed it, while 33% supported it. Asked if seniors would get lower quality care under ObamaCare, 65% of the doctors polled agreed and 28% disagreed. Asked if ObamaCare was passed, would they consider leaving their practices or taking early retirement, 45% said they would and 5% gave no answer. This means 360,000 doctors will consider quitting or Going Galt!

Who can blame them? They will be saddled with more paperwork, which is almost no one's favorite pastime. In order to try to fulfill its promises of more affordable health care, the government will put more pressure on doctors to reduce their fees and to spend less time with patients, thereby reducing doctor rewards both in remuneration and in personal satisfaction with a job well-done. With more patients per hour, more mistakes will be made and the number of litigious patients will increase, both leading to still higher malpractice insurance rates. Doctors will be underpaid and more weary even than now. What a life!

Massachusetts began the ObamaCare experiment in 2006. So have Hawaii, Tennessee, and Maine done similar experiments. In all of these cases, expenses increased faster than the national norm and doctor shortages became worse. Services had to be cut back. That is, rationing always resulted.

The Massachusetts Medical Society just released a study that found that insurance premiums are rising at a rate 22% faster than the U.S. as a whole. The doctor shortage is worsening due to the poor practice environment in the state. Primary care specialties (family and internal medicine) are in short supply for the 4th year in a row. The fraction of primary care practices closed to new patients is the highest ever recorded. Doctors in the dermatology, neurology, urology, vascular surgery, obstetrics-gynecology, family and internal medicine are in short supply. Recruitment and retention of doctors is very difficult, especially in primary care and in community hospitals.

Overall health spending, rather than complying with Obama's wishes, is higher than in the U.S. on average and growing faster, according to the Urban Institute. Apparently, Obama's wishes and claims carry less weight than does the law of supply and demand. The IBD survey found that this reality was well-understood by many doctors. 71% of them said they did not believe that "the government can cover 47 million more people and that it will cost less money and the quality of care will be better." It just is not understood by Obama and the Democrat Congress who are determined to use the force of government to force us all into their medical care hell.

Some may say that the American Medical Association (AMA) is backing ObamaCare, so the doctors must be backing it. The AMA only represents 18% of doctors and it is losing those who are members in large numbers because of its backing.

Great Britain's National Health Service (NHS) has a severe shortage of doctors. One-third of primary care trusts are flying in general practitioners from other countries to help them with their overloads. They actually fly in doctors from Hungary, Italy, Lithuania, Poland, Germany, and Switzerland, according to the British Daily Mail. Many of their resident doctors are already immigrants trained in other countries, in even much larger numbers than is the case in the U.S. or Canada, whose nationalized health care system is not as old as is Britain's. The overworked British doctors refuse to see patients at night or on weekends.

Canadian doctors can fairly readily emigrate to the U.S. and have done so in large numbers. What else is to be expected as a response to rigid work rules and income limits in Canada? The law of supply and demand always works, no matter what some people may wish and choose to impose through the use of government force.

Above all else, above the shortages, the increased costs, and the rationing of medical care that results with government controls, I worry most about the quality of the people who will choose to become doctors under this new regime. The most dedicated to their profession, the most independent-minded, the most creative, the most moral young people will Go Galt on the profession of medicine by refusing ever to become doctors in the first place. Only those who are easily brainwashed with the Obama duty to serve mantra will enter the field of medicine. The advancement and the quality of medical care will suffer horribly as a result during the lifetime of our children and grandchildren.

Many good doctors today will Go Galt and many a prospective good doctor will Go Galt by choosing a profession less enslaved by government. All good professionals are looking to enjoy their profession. They have the ability to excel in many professions, so why not choose one they will enjoy? My own daughter, Kate, worked in hospitals while earning her dual undergraduate degrees in Biotechnology and Biomedical Science with a 4.0 GPA while taking one-third more credits than she needed to graduate in four years. She decided she did not like the way medical care was already practiced and decided not to go to medical school. If medical practice were free of the harm already done by heavy-handed governmental regulations, I believe the profession would have had great appeal for her. As it is, she made the right decision to Go Galt on the medical practice profession and she made it without my input.

An Obama Lie: No Interference with Doctor-Patient

Obama tells so many lies that a rational observer almost has to assume that if he says something, then the opposite is true. Or, at the least, what he has said can never be given the credence of truth.

In his recent speech before a Joint Session of Congress, when Representative Joe Wilson rather indecorously declared Obama a liar to his face on one statement about illegal aliens not getting health care benefits, Obama lied about that and many, many other things as well. One of these was that once he establishes:

a publicly-sponsored insurance option, administered by government just like Medicaid or Medicare ..... I will make sure that no government bureaucrat or insurance company bureaucrat gets between you and the care that you need."

Michael F. Cannon points out that the Medicare program already gets between you and the care you need. It already has a review of care process in place to put pressure on doctors not to provide some of the care doctors are providing. He quotes a letter from a government bureaucrat involved in this review process. The bureaucrat points out that the doctors are between a rock and a hard place. If they do not lean toward giving more care given a severe medical condition with potential to become life threatening, then they are subject to lawsuits, which will cost them and their hospitals a fortune, even if the court decides in their favor. So, they are under great pressure to consider the worst case outcomes of denying care, rather than simply the straight odds. The review contractors and the reviewing bureaucrats have no such concerns at all. They do not consider the litigation consequences of denying health care.

And of course, the reviewers have the benefit of hindsight and they were not present to actually judge the health situation of the patient either. The records are all they have to go on. This is not always adequate.

A logical person would also consider Obama's claim that he would never let the government get between you and the health care you need if you pass his legislation to mean that Obama is President for Life and Eternity. If the logic of a program requires rationing, the program might deny that logic for awhile, but in the eternal life of government programs, it will eventually generally fall prey to its internal logic. Government-controlled health care must eventually ration health care as doctors become scarce and as expenses rise. You can count on it happening. Obama will not always be there to stop the program from rationing health care. Even if he were, he will no more stop the rationing then, then he has stopped the rationing already in the Medicare program, which is just now enlarging the review programs to ration care under his watch!

The Misunderstood 47 Million Uninsured

Over and over again, we are told that there are 47 million uninsured Americans. My own simple-minded Senator, Ben Cardin of Maryland, just wrote me an e-mail note attempting to justify the Children's Health Insurance Program with the opening sentence of "Currently, more than 47 million Americans lack insurance coverage and approximately 9 million of the uninsured are children." Then he and many others claim that health care is too expensive for Americans. We are to uncritically assume, and it appears that most of us do, that the 47 million uninsured Americans are uninsured because they cannot afford adequate or even inadequate health insurance. But, worst of all, this is a play upon our good nature and our concern for the welfare of other Americans, which is supposed to imply that if we wish to be a good person, we must be willing to consent to a partial enslavement of all of us and an extensive enslavement of health care professionals so that 47 million desperately poor Americans will have health care.

Charles, you say, it is outrageous that you equate proposed government-provider systems that would tax us all and then spread the health care benefits over all or some favored sub-group of Americans with partial enslavement of us all. And then you even say that the government regulation of the resulting health care system extensively enslaves American health care professionals. Just because we are going to force everyone to participate in this universal, one provider plan does not make it slavery. After all, we simply want to take care of those who cannot take care of themselves. To which I reply, when you do not allow people to manage their own lives, you have enslaved them. When you will not allow them to own their own life, the liberty to make their own choices, and to pursue their own idea of happiness, you have enslaved them. That you claim to be motivated by paternalism does not even differentiate yourself from the plantation owner of the antebellum South who often claimed he was taking care of those who could not care for themselves.

If there were 47 million Americans without health insurance and they could not afford it, then we would simply be in the situation of earlier times or of much of the rest of the world. But because we have had some respect for individual rights in America and we often claim that we believe in the right to life, liberty, and the pursuit of happiness, Americans have enjoyed a widespread prosperity which has greatly improved the lives of every income strata among Americans and has specifically delivered them the best health care system in the world. We provide a very disproportionate share of the medical innovation and win most of the Nobel prizes in Medicine, as well as those in the sciences, which often also support medical innovations. We develop a disproportionate share of the new drugs. Our medical professionals provide timely care for life-threatening medical problems which puts all of the basic care only and highly rationed higher end care provided by national medical systems in other otherwise advanced countries to shame. Canadians must come to the U. S. for many live-saving operations that Canada will schedule them for only after they are dead. This makes for an interesting approach to reducing the demand for operations which the state system would have to provide manpower and care for. Canada exports much of its medical expense to the U.S.

However, the 47 million Americans without health care insurance is a fraudulent figure. Of this 47 million, 10.2 million are not U. S. citizens. Of course, many of them are Americans, but only in the sense that they are citizens of countries elsewhere in the Americas! But this is not what most people are thinking when this figure is given. So, fewer than 37 million U. S. citizens are without health insurance.

The next important point is that many American citizens who have the means to buy insurance, choose not to do so. 8.5 % of those with household incomes greater than $75,000/year do not have health insurance. Of course, some fraction of these people have so much money that they are fully justified in regarding themselves as self-insured and there is simply no reason to pay a middleman. Bill Gates, Warren Buffet, and even The Donald have no need for health insurance. But, apparently a great many other people making good money do not need it either, although some of them do not have it simply because they are in the midst of changing jobs. There are 9.3 million of these well-off people. Then there are the rest of those who make more than the national average for a household and yet do not have health insurance. Of those households with incomes between $50,000 and $74,999 a year, 14.4% do not have insurance. This is another 8.5 million people. So, 17.8 million people can afford health insurance, but choose not to buy it. Again, many of this group are only briefly without insurance as they change jobs. A large fraction also goes without insurance because they regard themselves as too healthy to want to buy insurance to subsidize the health care of those who are less healthy! This is a manifestation of their pursuit of happiness. I have a nephew who has made this choice.

At this point, we are left with only 19.0 million Americans without health insurance. Of these, once again many are without health insurance only briefly as they change jobs. Some also are eligible for government health programs, but do not apply. John Stossel found that about a third of those eligible did not apply. Americans without health insurance make frequent use of hospital emergency rooms, which are required to provide them with medical care. They also use Medicaid in many instances. So, it is simply not the case that many millions of Americans cannot get medical care. Any implication that this is the case is fraudulent.

There are serious problems with our medical care system, but they will not be improved by making it a national system, if the problems rampant in Medicare and Medicaid can teach us any lessons at all. Or, if we can learn anything by examining the national health care systems of Canada or the United Kingdom. Our problem is that 86% of all American health care purchases are handled by third parties. This means that the patient has little to no incentive to demand cost-effective health care. The result is that little attention is paid to being cost-effective. My mother has a habit of asking medical care givers to justify the high costs of her and my Dad’s medical care and they very commonly are indignant that she cares. They say that she should have no interest in the matter, since she is not paying for it.

Another problem with our system is that it is so geared to the avoidance of legal suits, that one cannot get a straight answer from most doctors about almost any medical question. The profession has decided that certain procedures are to be considered acceptable practice and that if one stays strictly within those practices, then there should be no legal problems. This causes a different set of problems. For one thing, people are highly unique and what is statistically the most likely procedure to be successful, may well be the wrong procedure for a given non-conforming individual. Yet the doctor is unwilling to devise a procedure for the non-conformer, since to attempt to do so means he will have to leave the comfort zone of the accepted common procedure that protects him from law suits. In fact, I have heard of cases in which doctors gave advice they knew was wrong for a given patient, simply so they would remain consistent with convention. There are also cases in which the doctor believes that the chances for failure of a treatment are high and will not provide it even if that treatment is the only life-saving option for the patient. This is because to fail is to be open to a lawsuit.

So, if you actually do care about your fellow man, instead of making fraudulent claims about 47 million uninsured, do something to allow doctors and other medical professionals to really provide medical care without being totally paralyzed by fear of lawsuits. If you really care, let us change the tax code so that Americans will buy their own healthcare plans, be the guardians of their own costs, and be able to choose from many more treatment options which will be made available to them in a timely way.