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ObamaCare's Lost Tribe: Doctors; The practice of medicine is the Obama health-care law's biggest loser.
Topic Started: Jul 7 2012, 05:58 PM (302 Views)
Copper
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Shortstop

http://online.wsj.com/article/SB10001424052702304708604577505210356532588.html?mod=WSJ_Opinion_LEADTop

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ObamaCare's Lost Tribe: Doctors
The practice of medicine is the Obama health-care law's biggest loser.

Back at the at the dawn of ObamaCare in June 2009, speaking to the American Medical Association's annual meeting, President Obama said: "No matter how we reform health care, we will keep this promise: If you like your doctor, you will be able to keep your doctor. Period."

But will your doctor be able to keep you? Or will your doctor even want to keep you, rather than quit medicine?

For the longest time now, since day one of the Affordable Care Act, we have been having arguments over the mandate to purchase health-care insurance, requirements that insurance companies accept policyholders regardless of health, and price discrimination in insurance policies.
And of course this past week, the Supreme Court—or something resembling the Supreme Court—outputted a decision on the tax status of the insurance-purchase mandate, the states' obligation to pay for Medicaid and as a bonus, the Commerce Clause.

Have you noticed what got lost in this historic rumble? Doctors. Remember them?

ObamaCare has been a war over the processing of insurance claims. It has been fought by institutional interests representing insurance, hospital and pharmaceutical firms. The doctor-patient relationship, or what used to be called "the practice of medicine," has sunk beneath these waves.

Barack Obama, a savvy pol, understood from the start that rationalizing payments claims through the maw of these private and public bureaucracies was not what the average person thinks of as "health care." To any normal person, health care means that when you or yours get really sick, the doctors and nurses who attend to you will push all else aside to give you medical help.

Thus, the constant Obama chorus that you can "keep your own doctor." No one knows better than Barack Obama that his law sends the nation's doctors on a voyage into an uncharted health-care world in which they are just along for the ride with their patients.

A Wall Street Journal story the day after the Supreme Court ruling examined in detail its impact across the "health sector." The words "doctor," "physician" and "nurse" appeared nowhere in this report. The piece, however, did cite the view of one CEO who runs a chain of hospitals, explaining how they'd deal with the law's expected $155 billion in compensation cuts. "We will make it up in volume," he said.

Volume? Would that be another word for human beings? It is now. At Obama Memorial, docs won't be treating patients. They'll be processing "volume." And then, with what time and energy remains in the day, they'll be inputting medical data to comply with the law's new Physician Quality Reporting System (PQRS), lodged in the Centers for Medicare and Medicaid.

Here's the Centers' own description of what PQRS does: "The program provides an incentive payment to practices with eligible professionals (identified on claims by their individual National Provider Identifier [NPI] and Tax Identification Number [TIN]) who satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS)."

We're all pressed for thinking time these days, but the one group we should make sure has time to focus on what's in front of them is doctors treating patients. Instead, they'll also be doing mandated data dumps for far-off panels of experts.

Doubts, even among believers, have begun to emerge about what ObamaCare could do to the practice of medicine. A remarkable and important piece by Drs. Christine K. Cassel and Sachin H. Jain in the June 27 Journal of the American Medical Association directly asks: "Does Measurement Suppress Motivation?"

The question raised by the article is whether imposing pay-for-performance measurements on individual physicians does more harm than good: "[c]lose attention must be given to whether and how these initiatives motivate physicians and not turn physicians into pawns working only toward specific measurable outcomes, losing the complex problem-solving and diagnostic capabilities essential to their role in quality of patient care, and diminish their sense of professional responsibility by making it a market commodity."

This is an important piece, because Dr. Cassel is part of the intellectual foundation for the measured-directives movement. The saying that comes to mind reading these misgivings is that it's better late than never to notice that the core relationship between doctor and patient is being eroded. Except that in the wake of Chief Justice Roberts's upholding of the Affordable Care Act, it's too late and we're beyond never.

Mitt Romney needs a way to talk about health care in America. This isn't just a fight over insurance companies. It's about the people at the center of health care—doctors. The Affordable Care Act will damage that most crucial of all life relationships, that between an ill person and his physician. Barack Obama's assertion that we all can keep our doctors is false. You could line up practicing physicians from here to Boston to explain to Mr. Romney why that is so.



The Confederate soldier was peculiar in that he was ever ready to fight, but never ready to submit to the routine duty and discipline of the camp or the march. The soldiers were determined to be soldiers after their own notions, and do their duty, for the love of it, as they thought best. Carlton McCarthy
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Mikhailoh
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Just got back from a dinner party with several education professionals. We were discussing the effect of state and federal government mandates on measurement of outcomes that essentially dictate that, in special education programs, only a set percentage of students will pass. No more than that percentage will be allowed to pass, no matter the facts.

This same idiocy is about to be applied to your healthcare provider.
Once in his life, every man is entitled to fall madly in love with a gorgeous redhead - Lucille Ball
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Axtremus
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HOLY CARP!!!
Say ... how do you feel about Jack Welch's management philosophy of firing 10% of his managers every year? No more than 90% is allowed to "pass" onto the next year, no matter the facts.
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Mikhailoh
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Jack Welch is not an elected official and I am not seriously invested in GE stock, ergo I could give a flying flip what he does for management.

Would you like to ask a coherent or relevant question?

Once in his life, every man is entitled to fall madly in love with a gorgeous redhead - Lucille Ball
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John D'Oh
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MAMIL
Mikhailoh
Jul 7 2012, 08:46 PM
Would you like to ask a coherent or relevant question?

OK, here's a question. Why do American elections take f*cking years, while the rest of the world manages it in weeks?
What do you mean "we", have you got a mouse in your pocket?
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Axtremus
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HOLY CARP!!!
Very coherent, actually, at least for those who think that a President an elected executive branch official should run a country like a CEO runs a corporation; or that a nation-state should be run like a corporation in general.
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Mikhailoh
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It is a question. While it is coherent (especially goven the hour on Saturday night ^_^ ) it is not relevant.

Give the result, I will rephrase my question. Would you like to ask a coherent AND relevant question?
Once in his life, every man is entitled to fall madly in love with a gorgeous redhead - Lucille Ball
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Mikhailoh
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If you want trouble, find yourself a redhead
Axtremus
Jul 7 2012, 08:52 PM
Very coherent, actually, at least for those who think that a President an elected executive branch official should run a country like a CEO runs a corporation; or that a nation-state should be run like a corporation in general.
Many if not most of the same skills apply, even if the accountabilities are different. That does not mean the acts of one particular and very controversial CEO have any relevance.

See my revised question above.
Once in his life, every man is entitled to fall madly in love with a gorgeous redhead - Lucille Ball
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John D'Oh
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MAMIL
If you can't answer my question, just say so.


Years of our lives wasted, and we end up with Romney versus Obama. The 3 Stooges show up, except that one Stooge is missing.
What do you mean "we", have you got a mouse in your pocket?
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Axtremus
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HOLY CARP!!!
That's alright ... you characterized Jack Welch as "controversial." I infer that to mean you're not exactly a Jack Welch fan, which is fine by me.

[EDIT: left out the all-important "not" in the original; now fixed.]
Edited by Axtremus, Jul 8 2012, 04:01 AM.
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Axtremus
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HOLY CARP!!!
John D'Oh
Jul 7 2012, 08:55 PM
Years of our lives wasted, and we end up with Romney versus Obama. The 3 Stooges show up, except that one Stooge is missing.
C'mon, it's a huge improvement over G. W. Bush v. John Kerry.
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Mikhailoh
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Axtremus
Jul 7 2012, 08:58 PM
That's alright ... you characterized Jack Welch as "controversial." I infer that to mean you're exactly a Jack Welch fan, which is fine by me.
There is no sense in discussing your fantasies, unimaginative as they may be.
Once in his life, every man is entitled to fall madly in love with a gorgeous redhead - Lucille Ball
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Axtremus
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HOLY CARP!!!
Ahh ... left out the all important "not" in the original. Meant to say "... you're not exactly a Jack Welch fan ..."
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Jolly
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Geaux Tigers!
John D'Oh
Jul 7 2012, 08:49 PM
Mikhailoh
Jul 7 2012, 08:46 PM
Would you like to ask a coherent or relevant question?

OK, here's a question. Why do American elections take f*cking years, while the rest of the world manages it in weeks?
Because we do our best to get it right. And most of the time we wind up with a better product than most nations do.
The main obstacle to a stable and just world order is the United States.- George Soros
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ivorythumper
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I am so adjective that I verb nouns!
Axtremus
Jul 7 2012, 08:52 PM
Very coherent, actually, at least for those who think that a President an elected executive branch official should run a country like a CEO runs a corporation; or that a nation-state should be run like a corporation in general.
Why should a nation be run like a corp? Corps are later social organizations for signifantly more limited and special interest purposes than a nation. You might as well ask why a nation shouldn't run like a girl scout troop or a Rotary club.
The dogma lives loudly within me.
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Mikhailoh
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If you want trouble, find yourself a redhead
Axtremus
Jul 8 2012, 04:02 AM
Ahh ... left out the all important "not" in the original. Meant to say "... you're not exactly a Jack Welch fan ..."
Either way is incorrect and a fabrication of your own mind. I'm largely uninterested in Jack Welch's take on much of anything, including the presidency. The fact that the media sees the opportunity for low cost content does not make his musings relevant.

Your whole premise is flawed, at least when it comes to me. The only way I have ever related management of government to that of business is in the budgeting process. When you need to cut you should cut operational expenses across the board and let your line managers figure out how best to implement those cuts within guidelines.
Once in his life, every man is entitled to fall madly in love with a gorgeous redhead - Lucille Ball
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Copper
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ivorythumper
Jul 8 2012, 05:08 AM

Why should a nation be run like a corp?

It should be like a corp financially - it should turn a profit without resorting to taxation.

It should not be a mean old corp that wages war on women and poor people.
The Confederate soldier was peculiar in that he was ever ready to fight, but never ready to submit to the routine duty and discipline of the camp or the march. The soldiers were determined to be soldiers after their own notions, and do their duty, for the love of it, as they thought best. Carlton McCarthy
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