I have been pondering a post for several days on the probability that one of the first effects of Obamacare will be to reduce the number of doctors. If Obamacare is passed, I believe that from that moment, thousands of doctors will start to plan how to sell or close their practices and change careers.
I do not think doctors are going to say, “Yes, Obama, I do not deserve to make a good living as a doctor. I will take what you hand out. If it’s not enough to cover my current expenses, including my malpractice insurance since healthcare reform did not include tort reform, I will sell my house and move to a cheaper neighborhood. I’ll shop at Wal-Mart and Goodwill. I’ll fire the employees that I need to ensure prompt care and get along with the bare minimum of staff.”
My observation of the doctors I’ve worked with over the last 25 years as a caregiver for my late life partner and my parents is that in high school they were the smart, scientifically-inclined, ambitious kids who wanted to be their own boss yet were too risk-averse to be real entrepreneurs, so they chose medicine because it provided the independence they desired within a structured environment for career advancement and the near-certainty of making a six-figure income — and more if they were prudent, invested well or were real entrepreneurs able to found and build successful ventures. Oh, and they also crave honor and go to considerable lengths to earn it.
So doctors are not the type of people who passively accept having everything they’ve worked for yanked away — income, autonomy, honor, meaningful careers — as Obamacare would do.
What I predict will happen is that a significant percentage of doctors will decide that their skills are transferable to another profession where they will have the income, autonomy and honor they have earned and deserve. Maybe they will switch to a medically-related business. But what will really hurt public access to healthcare is that they will not be practicing medicine anymore.
The loss of this amount of training and talent — the death of so many medical careers — as one of the first consequences of Obamacare if it is passed, will be a type of Holocaust. It will be chillingly comparable to Stalin’s murder of plant geneticist Nikolai Vavilov and purge of a generation of biologists who defied Lysinkoism and dialectical materialism.
What prompted me to write this post was reading at Newsbusters the following statement by Dick Morris today from their full transcript of an interview with him this morning (8/21/09) by CBS’s “Early Morning” co-host Maggie Rodriguez. I have boldfaced the points I think are the most important:
MORRIS: I’m in favor of covering everyone, but I think the way to do that is first expand the number of doctors and the number of nurses. Expand the supply before you expand the demand. How is Obama going to cover 50 million new people without any more doctors or nurses? And the answer is he’s not. And what that’s going to mean is rationing, which primarily means that the elderly don’t get the medical care they get now. And I take this personally. My dad’s 99, and I can under – he’s doing fine. But I can understand the rationale that says, ‘well, he’s 99 and so on and so on.’ But-
RODRIGUEZ: Well, no, no, that’s – he still deserves it.
MORRIS: Boy, those years – those months and years are precious to me.
RODRIGUEZ: But yesterday, the President guaranteed that this would not only pass, but that it would pass without reducing [increasing] costs, without cheating anyone of care that they deserve, and by not adding to the federal deficit.
MORRIS: Well, first of all, how is he going to cut $200 billion from Medicare without cutting Medicare?
RODRIGUEZ: Well, he said – and I remember in July, I looked back at my notes this morning – he said it would not affect Medicare benefits.
MORRIS: He’s cutting Medicare by $200 million – $200 billion.
RODRIGUEZ: So we have to hold him to it is what you’re saying?
MORRIS: Well, what he’s saying is ‘I’m going to cut reimbursement rates to doctors and to hospitals.’ But if you cut reimbursement rates to doctors, you get shorter office visits and fewer office visits. And if you cut them for MRIs, you get fewer MRIs. And what this is going to ultimately lead to is fewer and fewer doctors, because their income is being cut, more and more patients, because the coverage is being expanded. And then when you say, ‘okay, who’s going to not get the medical care here?’ It’s the elderly, because they’re the ones that aren’t, quote, ‘fully entitled’ to it. They don’t benefit from it as much as a younger person. And I think this is just a catastrophe.
RODRIGUEZ: Well, maybe he can compromise with the Republicans, as you encouraged Bill Clinton to do, back in the day.
MORRIS: I don’t think he’s – I don’t think compromise is on his agenda there.
Rodriguez is functioning here not as a devil’s advocate but as a true believer of the White Queen School of True Believing whose graduates elected Obama due to their discipline of believing six impossible things before breakfast every day,* thus enabling them to believe ALL of the impossible and mutually-exclusive promises Obama made and makes to get their money, power, labor and votes with no intention of keeping the majority of his promises. Only people who truly have mastered magical thinking and abdicated their critical powers of analysis are able to believe that Obama is telling the truth when he says $200 billion in cuts to Medicare will not result in cuts in service and access.
I’m going to keep saying it until a critical mass of voters grasp this point: Obama is a sociopath who tells people what they want to hear in order to gain their trust and then he makes promises he does not intend to keep in order to get them to give him willingly whatever he wants from them. Whenever people realize he has ripped them off, he has a repertoire of behaviors to fend them off, invalidate their complaints and/or lead them on. He was trained in these techniques by followers of Saul Alinsky. But it also is how sociopaths behave. They are able to act in this way — making contradictory and mutually exclusive promises, alternating between charm and bullying, between persuasion and force — because they do not have the faculty that would give their behavior consistency to a set of values: they lack a conscience. Sociopaths also lack empathy, which results in their inability to feel the full range of emotions. The only emotion they fully feel is the thrill of power.
That is why Obama does not have compromise on his agenda. That is why Obama’s healthcare reform package will not make healthcare cheaper and more available by increasing the number of doctors, nurse practitioners, physician’s assistants and nurses. That is why Obama’s healthcare reform package does not include tort reform, or encourage competition by allowing the purchase of health insurance across state lines, or ban illegal immigrants from receiving healthcare or uncouple health insurance from employers. Obama’s healthcare package is intended to nationalize the healthcare industry — to transfer the power of making medical decisions from the patient-doctor relationship to bureaucrats who are not accountable to the people whose care decisions they will make. And that is why there is no fixing Obamacare. It must be defeated. And Republicans should be doing the hard work of drafting their own capitalism-based healthcare reform package — as Saul Alinsky pointed out in Rule 11 of his “Rules for Radicals,” you will not get a seat at the bargaining table if you just work to defeat a plan you don’t like — you must have an alternative to propose.
Expanding the supply of homegrown healthcare professionals before increasing the demand seems to me like one of the very best places to start.
* Through the Looking Glass by Lewis Carroll, Chapter Five:
Alice could not help laughing at this, even in the midst of her tears. ‘Can you keep from crying by considering things?’ she asked.
‘That’s the way it’s done,’ the Queen said with great decision: ‘nobody can do two things at once, you know. Let’s consider your age to begin with — how old are you?’
‘I’m seven and a half, exactly.’
‘You needn’t say “exactly”,’ the Queen remarked. ‘I can believe it without that. Now I’ll give you something to believe. I’m just one hundred and one, five months and a day.’
‘I can’t believe that!’ said Alice.
‘Can’t you?’ the Queen said in a pitying tone. ‘Try again: draw a long breath, and shut your eyes.’
Alice laughed. There’s no use trying,’ she said, ‘one can’t believe impossible things.’
‘I daresay you haven’t had much practice,’ said the Queen. ‘When I was your age, I always did it for half-an-hour a day. Why, sometimes I’ve believed as many as six impossible things before breakfast. There goes the shawl again!’
Yikes, I just realized even the White Queen doesn’t believe Obama can do two things at once. Probably because she’s a RAAAAAACIST! Off with her head!
Update, 9/16/2009, Wed.: Via Michelle Malkin, just as I predicted:
Investor’s Business Daily reports on the results of its heart-stopping poll of doctors:
Two of every three practicing physicians oppose the medical overhaul plan under consideration in Washington, and hundreds of thousands would think about shutting down their practices or retiring early if it were adopted, a new IBD/TIPP Poll has found
The poll contradicts the claims of not only the White House, but also doctors’ own lobby — the powerful American Medical Association — both of which suggest the medical profession is behind the proposed overhaul.
It also calls into question whether an overhaul is even doable; 72% of the doctors polled disagree with the administration’s claim that the government can cover 47 million more people with better-quality care at lower cost.