The Doctor-Patient-Government Relationship

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With respect to medical care, far too many Americans make assumptions that have no basis in reality. Two of the most pernicious ones will be greatly exacerbated now that the Affordable Care Act has been ruled constitutional. The first assumption is the idea that having health insurance is the equivalent of having healthcare itself. The second assumption is the idea that doctors will be beholden to the interests of individual patients above all else. Both assumptions are wrong.

First, having health insurance means nothing more than having the ability to pay for one’s health coverage. Coverage itself depends on having access to health professionals. With respect to that reality the numbers don’t lie. The most concerning reality is the additional number of people who will be getting insurance under Obamacare. CNN estimates that number to be 32 million. In addition, another 15 million Americans will become eligible for Medicare in the coming years. At the same time, the United States is experiencing a physician shortage. According to the Association of American Medical Colleges (AAMC), it is a growing phenomenon. By 2015, they estimate there will be a shortage of 63,000 doctors. That number balloons to 91,500 by 2020, and 130,600 by 2025. “The new AAMC projections reflect what happens with a relatively sudden increase in physician demand,” said Scott Shipman, M.D., M.P.H., senior researcher of workforce studies at AAMC. “From a projection standpoint, there is an exacerbated shortage in all areas.”

In 2006, the AAMC called for a 30 percent increase in medical school enrollment. The actual increase amounted to 13 percent. They further note that without an increase in Graduate Medical Education Slots (GMEs), increasing the number of doctors becomes impossible. Obamacare will redistribute a number of unused residency slots. It will also increase funding for the National Health Service Corps, an entity that put resident physicians and other healthcare professionals in health professional shortage areas (HPSAs). As of September 2009, about 65 million people were living in HPSAs — meaning they were already having trouble accessing healthcare. Yet increasing residency slots cost federal dollars, in addition to the cost projections for Obamacare that have already doubled since the law was passed.

Furthermore, medical school costs, which have long outpaced the cost of living, now top $250,000. Such costs are one factor driving medical students into medical specialties, rather than primary care medicine, which saddles would-be physicians with longer hours, less pay, and more administrative problems. That reality has also taken its toll: the number of U.S. medical school students going into primary care has dropped 51.8% since 1997, according to the American Academy of Family Physicians (AAFP). Since primary care doctors represent the front line in medical care, most people will be forced to wait far longer to see a “family doctor”–if they can find one at all.

And those are the people who still want to become, or remain, doctors. According to the St. Louis Front Page: “Despite the projected need for health care practitioners at all levels in a challenging job market, nearly half of high school-age students (45 percent of 13 to 18 year-olds) are not considering pursuing a career in health care and science fields.” Even more frightening, a survey conducted by the Doctor Patient Medical Association reveals a staggering 83 percent of current doctors are thinking about leaving the profession when Obamacare is fully implemented. That is likely an exaggerated number, but the trend is unmistakeable. Moreover, an increasing number of physicians are refusing to take new Medicare patients, because low reimbursement rates–which could go even lower–make it harder to stay in business. “Physicians are saying, ‘I can’t afford to keep losing money,'” said Lori Heim, president of the American Academy of Family Physicians.

Add up the above factors and one thing becomes crystal clear: the assumption that health insurance guarantees timely access to health care is nothing more than a pipe dream.

Which brings us to assumption number two. The traditional doctor-patient relationship is based on the idea that a doctor’s fundamental responsibility is to practice medicine for his individual patient’s benefit. Or at least it used to be. In 2002, the American College of Physicians published a charter declaring that the medical profession “must promote justice in the health care system, including the fair distribution of health care resources.” A 2011 article published in the New England Journal of Medicine declared that “the primacy of patient welfare” should be replaced with a system in which “physicians are collectively caring for a defined population within a fixed annual budget…” In other words, individual health considerations are trumped by those that benefit the collective.

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  • WildJew

    My immediate concern is the economy. If Obama is re-elected and this monstrosity continues to be put in place, I do not see any economic recovery; only further economic stagnation. Businesses are terrified what this man is doing to the free market. You talk to people who are working for the government, they are fine with Barack Obama but those of us out here in the real world, things aren't so good. The real estate industry has been decimated and property values have plummeted. People are watching their savings and property diminish under this nightmare Americans elected and support. Often I think I live in a nation full of idiots.

    • Bobby195

      You got that right………

    • deprogrammer

      So it's Obama's fault that the real estate bubble broke? Which broke BEFORE he became president? Property values are dropping down to what they should have been. If you over invested at the peak of the bubble and now are upside down then that is how the market is supposed to work.
      It sucks but that's the "free market". Lots of people get hurt and a few make huge amounts of money.

      • davarino

        Mmm, that makes me feel much better. Is that all you got?

        • Roger

          Nope, but you seem averse to reality.

      • fiddler

        Ever hear of Fannie Mae and Freddie Mack? How about Barney Frank and Chris Dodd? How moral is it to get people into homes they can't afford and eventually lose while being saddled with bad debt. But hey, it made the Democrats LOOK great.

        "The road to hell is paved with good intentions".

      • Roger

        Obama made it all worse.
        Communism does that. Marxism does that.

        Having a leader that wants his muslim heritage to win every conflict does that.

  • H&R_ Barack

    ObamaCare where HEARSE and NURSE shall become relative terms.

  • Bobby195

    Instead of climbing the ladder to success, all the mooch's want is someone to give them the ladder. No work ethic at all. If this bastard gets re-elected the nation that we used to know will be gone forever.

    • dennis metz

      the nations has been trashed for a while now, the only real hope is if texas becomes a county and straightens the mess out and gives honest hard working people a place to live and work, reform welfare and afirmative action be gone

  • ApolloSpeaks


    Growing physician shortages + growing physician demand (32 million new people covered by ObamaCare) = long and growing waiting lines to see doctors and get necessary medical care.

    In Canada and Great Britain the waiting lines to see doctors and enter hospitals are one million strong. According to the Massachusetts Medical Society waiting time in their state since passage of RomneyCare is now 48 days (double the national average) as more and more doctors turn away patients.


    • dennis metz

      having a shortage results in them pushing losers and unqualified jerks through the system, our system is full of under qualified people at all levels of health and many of them could care less about patients or bed side manners

  • ApolloSpeaks

    This healthcare nightmare is not what Americans want. Forget about what Justice Roberts did for now. DONE IS DONE! Use the hidden horrors of ObamaCare: scarcity, rationing, agonizing waiting lines and higher taxes, to kill the Obama presidency on November 6th.




    • Looking4Sanity

      No one is going to believe it until they are subjected to it, and then it is WAY too late.

      • daisy

        Absolutely. It isn’t real to them yet because they haven’t experienced it. And those who KNOW healthcare in the UK don’t believe it will be like it is there.

        • Looking4Sanity

          Unfortunately, that is the world we live in today, Daisy. The vast majority have no interest in the Common Good any more. It's all about what they can get for themselves and hang everyone else. They are too blind to realize that they are, in reality, building their own gallows.

    • mlcblog

      Our only hope is a Repub sweep in 2012 and even then we need a strong spine of political will to repeal this disaster.

    • Roger

      I will not forget what Roberts did.
      It wasn't just the Obamacare betrayal, it was the EPA unleashed and the Arizona state knee cap.

      Roberts needs to resign, but he better wait until after January when Obama has been replaced first.

  • Johncdavidson

    The minute you walk in the door of a VA Clinic you are no longer considered a person; you become a negative number.

    • mlcblog

      That's funny, a negative number, if it weren't so sad. I used to work at a large VA hospital so I know the gallows humor it takes to survive the circus of events. We used to say, Do they sell tickets?

      A govt hospital is extremely inefficient. I have worked in a private HMO, too, and they are very efficient and try to be cost-effective yet provide good health care and have been doing it for years. Employees were expected to perform well, up to standard, or they were not kept on.

      • Johncdavidson

        I've heard and have several friends that have some real horror stories about the VA system here in Ohio. One was a former co-worker that took a trip 70 miles to get medication; was denied, drove home, next morning, blew his brains out in his driveway.4 years later, the fellows grandfather 80 who's wife was sent to nursing home was found by grandaughter lying naked after appointment cancelled by social worker to get someone to look out for him. It just a shame.

        I did get congressman to file 6 complaints with the VA committee in DC that I had with large clinic in Columbus. They did stop charging for eye glasses later. Most of the primary doctors are foreign just fullfilling residency requirements that basically just allolwed to refer patients to specialists. Those appointments usually are for a month later.

        I just keep the coverage so they'll have to pay for the local emergency room care here. There drugs are priced twice what you can pay for them on the street.


  • Steve Chavez

    ANALOGY: "ObamaCar."

    What would happen to the AUTO INSURANCE INDUSTRY if they were suddenly forced to cover PRE-EXISTING CONDITIONS that includes everything that is wrong with your car like ENGINE REPAIR, TIRES, AND BODY DAMAGE and from people who barely started a policy, and paying its first premiums but OBAMACAR DEMANDS FULL COVERAGE??? What happens if the insurance REFUSES?

    • deprogrammer

      We aren't talking about cars we're talking about human life.
      Those are different you know.
      *sigh* FPMers always seem to have problems distinguishing people from inanimate objects.

      • Roger

        Yet the analogy stands.

        Reality is a harsh place for you, isn' t it?

      • Karen

        right…a totally ridiculous analogy that doesn't make any sense whatsoever. some people just want to be afraid.

  • oldtimer

    I'd like to know what "affordable" means. My friend's minimum indivudual coverage(hospital/emergency/dr., if admitted to hsp), because of the measures that went into effect this year, went up 81%. That's outrageous! I don't know what it was, but if it was $300 pm and went to $540, what will it be when the next round goes into effect. I sure could not afford to pay close to/or more than $1000 per mo, can you.

  • mrbean

    The assumption that you have a right to healthcare is invalid. How did this assunption come about? The full story is a long and complicated one, but the essential cause, is simple. The essential cause is the assumption that if people have medical needs which are not being met, some say it is society's responsibility to meet them. In the current debate over health care reform, universal access has become the unquestioned goal, to which all other considerations may be sacrificed. The assumption is that the needs of recipients take precedence over the rights of physicians, hospitals, insurers and drug companies — i.e., the producers of health care, the people who deliver the goods — along with the rights of the taxpayers who are going to have to pay for it. In other words, those with the ability to provide health care are obliged to serve, while those with a need for health care are entitled to make demands. It is patently Marxist as "Each according to his needs, and each according to his abilities" – or what one man is incpable of or unwilling to provide for himself shallbecome the forced burden of another.

  • clarespark

    Dr. James Pagano, an ER doctor, wrote two blogs on this subject. The more recent one is here:…. Read the interesting comments too, that add more statistcs on the inevitable outcome of ACA.

  • Looking4Sanity

    I pity all those who fear hunger, sickness and death and live under this regime. Each day will be a burden and a curse to them.

  • Tatersalad

    "Read My Lips – No New Taxes" !!!!!!!!

    Democrats are running away from this countries biggest tax hike in American history:




    4. Barack Obama evoking Jesus to sell us the more taxes while we are "broke":

    5. 20 New higher taxes that American citizens will "enjoy" now that Obamacare is constitutional:

  • jacob

    I had today the oportunity of lisistening to a speech by President REAGAN, warning us about the end results
    of this OBAMACARE, words that to me are simply prophetic…

    He said that it was going to be the Trojan Horse for socializing the USA and there is where we are headed
    to if we allow this disgraceful President to be reelected…

    And then it will be of no use to weep like women for what we refused to defend like men…..

    • Roger

      Our leadership looks awfully shallow when you hear Reagan speak again.