RoR: Forum

"can't possibly" ? Not a phrase of reason perhaps.
It seems more likely solutions will be found at great cost.

Post 1

Thursday, August 23, 2012 - 4:39am

Martin,

Welcome to RoR.

You mention how "can't possibly" is such a strong statement that it is likely to be unreasonable, but -- while generally true -- sometimes the specifics of a case (the context) can make such a strong statement true. Leonard Peikoff gives the example of a really old and weak man running the mile in under 4 minutes and then having a baby (giving birth). In this limited context, it is perfectly reasonable to say that that "can't possibly" happen. I will add, for illustration, that you "can't possibly" get a "13" by rolling two normal dice. So, limiting the context, it can be reasonable to use the phrase: "can't possibly." The linked article by John C. Goodman includes limits on the context, indicating that the limiting factor is not money (as you alluded), but time:

ObamaCare says that health insurance must cover the tests and procedures recommended by the U.S. Preventive Services Task Force. What would that involve? In the American Journal of Public Health (2003), scholars at Duke University calculated that arranging for and counseling patients about all those screenings would require 1,773 hours of the average primary-care physician's time each year, or 7.4 hours per working day.

Bottom line: To meet the promise of free preventive care nationwide, every family doctor in America would have to work full-time delivering it, leaving no time for all the other things they need to do.

When demand exceeds supply in a normal market, the price rises until it reaches a market-clearing level. But in this country, as in other developed nations, Americans do not primarily pay for care with their own money. They pay with time.

How long does it take you on the phone to make an appointment to see a doctor? How many days do you have to wait before she can see you? How long does it take to get to the doctor's office? Once there, how long do you have to wait before being seen? These are all non-price barriers to care, and there is substantial evidence that they are more important in deterring care than the fee the doctor charges, even for low-income patients.

So what Goodman is really saying is that while we can 'inflate the currency, tax the rich, or borrow from China' in order to fund ObamaCare as it stands, we cannot get more than 24 hours out of a day. Left as it stands, ObamaCare would require us to create more hours in the day. Now, that's left as it stands. That's looking at the promises of ObamaCare and not making any adjustments in them. In reality, adjustments in the promises of ObamaCare will be made -- because there is not enough time in a day to realize them as they currently stand -- but that's different than providing exactly what was promised, only at a "great cost."

Ed

Post 2

Thursday, August 23, 2012 - 8:10am

Ed,
The article you quoted indicates that providing counseling on preventive care screening is a service provided by the physician. Health management activities, as they have come to be known in the healthcare industry, are not always performed by the physician, especially in large practices. Usually, it's a nurse, medical assistant, health coach, or some other type of professional who does this. That said, it doesn't change the fact that someone will have to do it, and the hours it takes will still be expended. It also highlights, yet again, that it's the small practice physician who will suffer the first wave of negative impacts.

Post 3

Thursday, August 23, 2012 - 9:03am

I think that it should be clear by now that Obamacare was designed as a Trojan horse to transition America from where we were to a single-payer system - to a full-blown government cradle to grave health system where there are very few to no private providers. Doctors will all be government employees, no private clinics, no private hospitals and no health insurance companies.

Obama himself, and a number of other top progressive politicians were caught saying as much on camera and the people involved in crafting the legislation and the people advising the administration on these issues are all advocates of single-payer health care systems. From that perspective you have to say that things like transferring 716 billion from Medicare to Obamacare, the reduction in payments to Medicarae providers, the unrealistic requirements that private insurance has to meet, the encouragement of employers to pay a fine that is cheaper than paying for insurance, and so many other features are just the way that alternatives to Obamacare are slowly but steadily crushed so as to push people into Obamacare.

Its lies and inconsistencies are actually built-in, time-released transformation mechanisms - each one set up to booby-trap some aspect of some alternative to a single-payer system. It's very messy and an evil, cynical way to abuse the legislative process. (I so wish that our constitution had a mechanism whereby a majority of the State Attorney Generals could institute impeachment and/or criminal proceedings against elected officials in the House, Senate or White House where it could be shown they are pushing dishonest and fraudulent legislative packages!)

Every future problem of implementing Obamacare and its many contradictions will just be an exercise in being forced to make changes, whether they show up as a large or a small crisis, in ways that will further the real agenda: squeeze out the alternatives to Obamacare till it can be converted to a single-payer system while saying that the free market failed to provide people with the health care they are entitled to.

(Edited by Steve Wolfer on 8/23, 10:34am)

Post 4

Wednesday, August 22, 2012 - 5:25am

http://www.gapminder.org/world/#$majorMode=chart$is;shi=t;ly=2003;lb=f;il=t;fs=11;al=30;stl=t;st=t;nsl=t;se=t$wst;tts=C$ts;sp=4.74129032258064;ti=2011$zpv;v=1$inc_x;mmid=XCOORDS;iid=phAwcNAVuyj1jiMAkmq1iMg;by=ind$inc_y;mmid=YCOORDS;iid=phAwcNAVuyj2tPLxKvvnNPA;by=ind$inc_s;uniValue=8.21;iid=phAwcNAVuyj0XOoBL_n5tAQ;by=ind$inc_c;uniValue=255;gid=CATID0;by=grp$map_x;scale=log;dataMin=282;dataMax=119849$map_y;scale=lin;dataMin=12;dataMax=83$map_s;sma=49;smi=2.65$cd;bd=0$inds=;modified=75

is a site showing the facts in 3D graphing

Post 5

Thursday, August 23, 2012 - 6:51pm

Deanna,

You bring up a good point. In larger health care facilities, there is not just a doctor and a nurse, but there is more like a "health team" -- something small-practice physicians don't have. Many of the screenings in larger health care facilities could be performed by an array of health care professionals, as you said. So, just as Obama has hurt small businesses with his crony-capitalism and big-business ("too big to fail") government handouts, his health care plan will hurt the small practitioner -- either driving him all of the way out of business or, in the least, seriously economically damaging him.

Ed

Further
Some "recommendations" which might eventually become mandated under ObamaCare

Some more "recommendations" -- which might all eventually become mandated under ObamaCare:

U.S. Preventative Services Task Force recommendations for adults (cancer; heart and vascular diseases; injury and violence; infectious diseases; mental health conditions and substance abuse; metabolic, nutritional, and endocrine conditions; musculoskeletal disorders, obstetric and gynecologic conditions, miscellaneous)

U.S. Preventative Services Task Force recommendations for child and adolescents (cancer; heart and vascular diseases; development and behavior; infectious diseases; injury prevention, mental health conditions and substance abuse; metabolic, nutritional, and endocrine conditions, musculoskeletal disorders, perinatal care, vision and hearing disorders)

Post 6

Friday, August 24, 2012 - 4:14am

Neat graph, Martin, but it shows nothing about the topic of this thread.

Post 7

Friday, August 24, 2012 - 10:24am

Thing is, a lot of the recommended screenings are already being done. The source of recommendations now, however, are actual medical professionals, you know people who are actually trained and experienced in the medical fields they represent. If you call up a random sampling of healthcare organizations, I'd be willing to bet that a large percentage of them can easily direct you to their documented best practices for preventive medicine (i.e. if you're a 40-year-old woman you should be having an annual mammogram, but if your mother died of breast cancer you should start annual mammograms immediately, etc). The small practices may not have it documented as formally, but if asked, they could tell you.

And counseling patients (about obesity, smoking, etc) is part and parcel of any good physician's practice. They don't need 9 yards of legislation to tell them to do it.

What sticks in my craw (yes, Ed, I know my Tennessee is showing) is that this task force is going to end up populated with a bunch of people who donated a bunch of money to some politician's campaign but never practiced medicine in their lives. And those yahoos are not just going to set the standards, they are going to make the physician's required documentation so freaking complicated and time-consuming that all the good doctors are going to retire to Florida. Leaving me with a dickwad who doesn't know (or possibly even care) that my family's history predisposes me to heart disease, but he'll order up some bloodwork to check cholesterol and give me a pamphlet about exercise and a low-fat diet because some task force told him to. That is, if I can ever get in to see Dr. Dickwad, and let's hope my results don't require any actual interpretation because all he'll be able to do is check the standard and reference the pamphlet.

Don't even get me started on personal responsibility.

(Edited by Ms. Deanna Delancey on 8/24, 1:50pm)

(Edited by Ms. Deanna Delancey on 8/24, 1:51pm)

Post 8

Friday, August 24, 2012 - 7:03pm

Deanna,

Colorful, yet poignant. Impressive. Here is formal research showing that you hit the nail right on the head, regarding what can perhaps be no better characterized than the ... wait for it ... the Dr. Dickwad Dilemma (wherein self-appointed elites make edicts while disregarding professional opinions of hands-on practitioners):

=============
2011
United States Preventive Services Task Force screening mammography recommendations: science ignored. [see this link to the full-text journal article]

2010
The 2009 US Preventive Services Task Force (USPSTF) guidelines are not supported by science: the scientific support for mammography screening.

The recent US preventive services task force guidelines are not supported by the scientific evidence and should be rescinded.

US Preventive Services Task Force recommendations for screening mammography: evidence-based medicine or the death of science?

=============

Evidence-Based Medicine (EBM) is a double-edged sword. It's good for summing up findings into an aggregate measure of risk/cost/benefit, but some issues are best left "unaggregated."

Ed

Post 9

Tuesday, August 28, 2012 - 5:12pm