Kill Grandma Or Die

The excellent James Taranto is excellent.  Yup, and the sun rose in the east this morning.

Comments

[drjohn]

Democrats have passed beyond simple stupidity into the twilight zone of sheer desperation.

It's become quite amusing.

[The race card is trumps.]

Taranto must be some kind of idiot. Of course, Trudy Rubin is right. It's Bush's fault.

And yet, she was right about the failure of Obama's signature issue weakening his Presidency. How did she forget to mention all the racist opposition?
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[Neo]

He didn't quite finish off the Clinton experience, but, if my memory serves me right, Clinton turned to foreign policy as a source of "successes" after HiliaryCare crashed-and-burned. All the more incentive to hope for the demise of ObamaCare.
I bet, at this moment, the Poles and Czechs are wishing Obama an early retirement.

[clarice]

He is brilliant and I , too, loved that column. Let's be honest though, people like Trudy--well, it is like hitting the side of the barn, isn't it.

[Pofarmer]

Ya know, one wonders what kind of decisions that Obama would have had to make if Bush hadn't made those "wrong headed" decisions with regards to Afghanistan, Pakistan, and Iran.

How many more U.S. buildings would be "places of reflection?" How many more U.S. embassies attacked and turned to dust?

How quickly people forget.

[Neo]

To understand the bitterness in Poland, 70 years ago today, the headline in the New York Times read "Russians Drive 40 Miles Into Poland, Defense Weak; Polish President In Rumania, Warsaw Holding Out; Britain and France, Concerned, Consult On Action

[bishop]

Sadly that's considered a moderate voice in our paper, I'm sure that column will be flagged for tomorrow if not Sunday. I remember she explained her approach to Iraq
because she grew up Jewish in apredominantly
Irisjh neighborhood, WTH does that have to do with Islamic extremism, your guess is as good as mine. It's the bizarro presidency, do the opposite of what every reasonable person would do.

[Pofarmer]

O.K.

Since this has the kill Grandma tag, can I make a little health care comment here?

Did a little looking on Med School enrollments, and I think I kinda stumbled on part of the problem.

"Medical schools consider boosting enrollment"

http://media.www.tcudailyskiff.com/media/storage/paper792/news/2009/01/29/News/Medical.Schools.Consider.Boosting.Enrollment-3601634.shtml

We've been in a supposed Dr. shortage for 10 years and just now they are looking at boosting enrollment? Good Lord. In 2008 there were only 18,000 students enrolled in ALL the medical schools in ALL the U.S.????? WTF???? Who planned this?

The incredibly low acceptance rate at medical schools, combined with the high salaries of Dr.'s, has been SCREAMING for more graduates of Medical schools for the last TWENTY FREAKING YEARS.

There's your health care crisis, in a nutshell.

[Pofarmer]

Geez

From 1982-83, to 2006-2007 Med school enrollments increased by ONE THOUSAND TOTAL.

http://www.aamc.org/data/facts/charts1982to2007.pdf

And, yet, we get arguments like this from the AAMC.

http://www.physicianscholar.org/print/id/708085

You see, we already have enough Dr.'s, and, adding more, will mean the ones already here won't get to charge as much.

Argument against...
Presented by Kevin Christensen

At first glance the AAMC's proposal may seem reasonable because there is a shortage of physicians in many specialties across the country, especially in primary care. However, this shortage is a symptom of a deeper problem with our healthcare system that the “quick fix” solution of expanding medical school enrollment will not solve. In fact, it may even make it worse.

The medical education system and physician payment system in this country discourage students from entering primary care. Two important ways the medical education system does this is by 1) the rapidly rising cost of medical school (with average student debt exceeding $120,0001) and 2) the long length of training required (4 years of medical school and 3 + years of post graduate training). These facts, combined with the comparatively low salary of primary care fields causes students to choose other more lucrative fields2.

Therefore, increasing medical school programs will not fix the primary care shortage. Instead, more students will enter subspecialty areas that pay more and that may or may not already be saturated with physicians. The problem is that the physician compensation model in this country allows physicians to be market makers. Physicians can induce demand for their services and they have incentive to do so in the fee-for-service system. Hence, simply increasing medical school enrollment can actually hurt the American heath care system by increasing the number of highly skilled and highly paid specialists with the ability to create demand for their services. This will increase unnecessary spending and inflate America’s already enormous health care bill3.

Research done by John Wennberg at Dartmouth suggests that this in fact has already occurred. According to his data, if this country practiced as efficiently as the Mayo Clinic, there would be a surplus of 47,000 physicians by the end of 20174.

The real solution to the perceived physician shortage is to eliminate unnecessary spending and increase the efficiency and value of the healthcare system.

[DebinNC]

"The survey showed 44 percent of medical schools reported an applicant's MCAT score is the most important factor in the admissions process, which is a 10 percent increase from the 2007 survey's results. The second most important factor, according to the survey, was a student's GPA."

What do the other 56% of med schools go by? I hope race doesn't become more of a factor, as it does in HR 3200. If they have genuine financial need, I would support fed help for the best students applying to med/nursing schools, but not if race trumps MCAT/SAT scores.

[Greedy docs; yep, they're the problem.]

Many years ago, Pof, there was a tongue in cheek proposal that Medicare give every graduating MD a brand new Jaguar, the idea being that such a gift would pre-empt some of the new doctors' greed. The really amusing thing about the proposal is that would probably have been cost effective.
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[Ranger]

From 1982-83, to 2006-2007 Med school enrollments increased by ONE THOUSAND TOTAL.

Posted by: Pofarmer | September 18, 2009 at 09:15 AM

Hmmmm.. Funny you should mention that. I seem to recall that in the late 70s or very early 80s there was a huge expansion of medical shcool class sizes under way. The AMA paniced and established strict caps for each of the med schools, then got congress to actually pay full tuition for empty class seats while the med schools scaled back down to their new AMA aproved smaller sizes.

[Pofarmer]

Flat medical school enrollments, in a time where the population has increased nearly 30%, gotten older, and more and more procedures are performed, is almost criminal. It's certainly stupid.

[Pofarmer]

Hey Ranger, is there any solid information on that? I would love to see it!!!

Right now, I gotta go to work.

[Charlie (Colorado)]

"Medical schools consider boosting enrollment"

Hey, ten years ago they were considering if enrollment was too great.

[Charlie (Colorado)]

The "greedy doctors" thing is over the top, though. I knew a number of my med school classmates who net rather less than I do, especially OB/GYNs and family docs, and I hardly ever have to get out at 3AM in a snow storm to deliver an emergency white paper. When you have to pay for medical offices, a couple of nurses, and an OB/GYN's malpractice insurance — on average, an OB/GYN is sued every third year — it cuts into the fees pretty badly.

[Ranger]

I was wrong about the time frame, it was 1997:

http://money.cnn.com/magazines/fortune/fortune_archive/1997/10/13/232499/index.htm>WASHINGTON AND THE DOCTOR GLUT GOOD THING THEY DIDN'T TAKE OVER HEALTH CARE

By RONALD HENKOFF
October 13, 1997

As part of the balanced budget legislation recently passed by Congress, Medicare will reimburse hospitals only for the number of residency slots they had this year; there won't be any subsidies for new positions. Washington also will offer hospitals a nice incentive to downsize: Those that cut the number of resident positions by 25% over five years will receive "transition payments" equal to 100% of their 1997 subsidies for the first two years, tapering off to 25% by the fifth year.

Or, to put it in stark clarity:

The government solution to this "glut" of doctors, is to subsidize the training hospitals $100,000 a year for each doctor they "don’t train." So: we get to pay for doctor training, and for our money, we don’t get doctors. http://www.spectacle.org/497/wilson.html>(Makes perfect sense if you are a government bureaucrat.)

[clarice]

But there's the satisfaction, Chaco, of knowing that your fees are adding another wing to the Edwards' manse.

[Ranger]

Found another one:

http://www.cnn.com/HEALTH/9708/24/doctor.glut/>Report: U.S. to pay hospitals not to train doctors

By the way, this was sold at the time as a way to reduce future Medicare costs... Apparently the theory was less doctors means less medicine being practiced, so less Medicare payments to be made. It apparently never occured to anyone at the time that it might just mean overworked doctors in the future.

[National preservation is quaint.]

Chaco, 10:06, I've a friend, an older physician, who's never been sued, who is completely toasted on working within the present system, but still has a passion and God given aptitude for patient care.
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[Ranger]

I do like this from the end of the one article:

Others wondered whether it was necessary. The number of doctors training to become specialists in some fields has declined dramatically despite the subsidy program, the Post article said, due to well-publicized warnings that jobs for specialists were only available in less populated areas.

Funny how market forces seem to correct this kind of problem on their own.

[Semantic Putz]

In Which Rep. Joe Wilson, (R-SC) Is Vindicated

[Charlie (Colorado)]

I've a friend, an older physician, who's never been sued, who is completely toasted on working within the present system, but still has a passion and God given aptitude for patient care.

What's his speciality/area? Odds on he doesn't deliver babies. Family docs don't have as much trouble with malpractice, but have the problem that they end up treating a lot of Mdicare/-caid patients for whom they don't get reimbursed.

In any case, one of my classmates who had the passion etc basically just stopped practicing because she had a couple kids, and couldn't both spend time with them and practice enough to break even on the insurance.

[Frau the Schnauzer]

"But there's the satisfaction, Chaco, of knowing that your fees are adding another wing to the Edwards' manse."
Clarice, it's either a walk-in fully mirrored vanity/preening center or a nursery for "his campaign worker's baby."

[clarice]

Certainly not the screening room for watching the Edwards and Reille video.

[Pofarmer]

It apparently never occured to anyone at the time that it might just mean overworked doctors in the future.

It also means that we didn't get the clinics these Dr's would have operated and the myriad other services that more Doc's would provide.

Chaco, That's why there's fewer and fewer OB GYN's. Put more docs in ALL specialties, and, eventually, the level evens out.

[Jane]

Hey what ever happened to that Grand Jury? Are they still pondering whether to indict Edwards?

[Pofarmer]

How was there ever a Dr. Glut? We've been having trouble getting Docs to the hinterlands since the '80's.

[Sara (Pal2Pal)]

I'd like to know when the last time you had a doctor where English is his/her first language? In the 6 years that I was intimately involved with the health care industry as my Mother's caretaker, not once did she see a doctor who was actually born in America. The majority were Asian, Pakistani, and from India. Her primary was from China, had two sons at Harvard Medical and no one ever knew what he was saying, what instructions he was giving or what medications he was prescribing. My Mother would nod politely and then when we'd get outside his office, she'd look at me and ask, "did you understand a word he said?"

[Pofarmer]

Hell, sara, I've never even seen my DOCTOR. The two or three times I've been to the office the last 5 years or so have all been with the Nurse practioner, cause the Doc is booked up four months or whatever.

[What's that little black foot doing in there?]

UR right, Chaco; that one's OB is only ER.
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