ARC's 1st Law: As a "progressive" online discussion grows longer, the probability of a nefarious reference to Karl Rove approaches one

Monday, April 27, 2009

The Aristocracy of Pull, Part 6

Another Rovian Conspiracy has pointed out numerous instances where the desire to centralize & nationalize economic decisions only increases the likelihood of corruption and reduces the freedom of the individual.

This story from points to the problem of government regulation which results in market inefficiencies, resulting in the government trying to resolve them through regulation or incentives, which invariably attracts "special interests" to make sure those regulations or incentives favor them.

Obama administration concerned about growing shortage of primary-care doctors
by Robert Pear/New York Times
Sunday April 26, 2009, 9:59 PM

Washington -- Obama administration officials, alarmed at doctor shortages, are looking for ways to increase the number of physicians to meet the needs of an aging population and millions of uninsured people who would gain coverage under legislation championed by the president.

The officials said they were particularly concerned about shortages of primary-care providers who are the main source of health care for most Americans.

One proposal -- to increase Medicare payments to general practitioners, at the expense of high-paid specialists -- has touched off a lobbying fight.

Family doctors and internists are pressing Congress for an increase in their Medicare payments. But medical specialists are lobbying against any change that would cut their reimbursements. Congress, the specialists say, should find additional money to pay for primary care and should not redistribute dollars among doctors -- a difficult argument at a time of huge budget deficits.
Replace the consumer in the health care system from the individual to the government and the government is the new customer. Therefore, the providers start to market to their new customer (which doesn't need health care, just campaign cash).
To cope with the growing shortage, federal officials are considering several proposals. One would increase enrollment in medical schools and residency training programs. Another would encourage greater use of nurse practitioners and physician assistants. A third would expand the National Health Service Corps, which deploys doctors and nurses in rural areas and poor neighborhoods.

Sen. Max Baucus, Democrat of Montana, chairman of the Finance Committee, said Medicare payments were skewed against primary-care doctors -- the very ones needed for the care of older people with chronic conditions like congestive heart failure, diabetes and Alzheimer's disease.

"Primary-care physicians are grossly underpaid compared with many specialists," said Baucus, who vowed to increase primary-care payments as part of legislation to overhaul the health-care system.
The experience of Massachusetts is instructive. Under a far-reaching 2006 law, the state succeeded in reducing the number of uninsured. But many who gained coverage have been struggling to find primary-care doctors, and the average waiting time for routine office visits has increased.

"Some of the newly insured patients still rely on hospital emergency rooms for nonemergency care," said Erica L. Drazen, a health policy analyst at Computer Sciences Corp.

The ratio of primary-care doctors to population is higher in Massachusetts than in other states.
Of course, I don't think health care rationing was the goal of the Massachusetts law, but I could be mistaken.

I would submit that the reduction in primary-care physicians is positively correlated to the decrease in the probability of a profitable career as a primary-care phycisian. I mean, going through school to take on huge amounts of debt with the ultimate goal of seeing & helping sick people every day is fine, but there's got to be some remuneration involved.

This is what happens when you turn over control to bureaucrats and elected officials. They, numbering in the hundreds, must make the decisions about supply & demand which historically would have been made by 300 million independent actors in the form of consumers.

Previous examples of the Aristocracy of Pull available here.

Your Co-Conspirator,
ARC: St Wendeler