Medicare doctors

Not every doctor accepts medicare patients.  Many doctors only accept a few.  The same is true of medicaid patients.  This is because government payments are less than the going rate for their services.  This could become a problem.

The number of doctors refusing new Medicare patients because of low government payment rates is setting a new high, just six months before millions of Baby Boomers begin enrolling in the government health care program.

Recent surveys by national and state medical societies have found more doctors limiting Medicare patients, partly because Congress has failed to stop an automatic 21% cut in payments that doctors already regard as too low. The cut went into effect Friday, even as the Senate approved a six-month reprieve. The House has approved a different bill.

• The American Academy of Family Physicians says 13% of respondents didn’t participate in Medicare last year, up from 8% in 2008 and 6% in 2004.

• The American Osteopathic Association says 15% of its members don’t participate in Medicare and 19% don’t accept new Medicare patients. If the cut is not reversed, it says, the numbers will double.

• The American Medical Association says 17% of more than 9,000 doctors surveyed restrict the number of Medicare patients in their practice. Among primary care physicians, the rate is 31%.

The federal health insurance program for seniors paid doctors on average 78% of what private insurers paid in 2008.

“Physicians are saying, ‘I can’t afford to keep losing money,’ ” says Lori Heim, president of the family doctors’ group.

via Doctors limit new Medicare patients – USATODAY.com.

We’ve got to cut medical expenses, we keep saying.  That means doctors will get less money.  But what if doctors won’t work for what we want to pay?  Shouldn’t doctors, like other economic players, be able to set the fees the market will allow?  Or should they be forced to serve anyone who comes into their offices?

How the health care law will be enforced

A major argument against the government taking over Americans’ health care is competence, the fear that the government is just not competent enough to supervise such an important part of life.  Here is an example:

The IRS processed more than 230 million tax returns last year, paid 127 million refunds and received about 68 million phone calls. The agency is responsible for enforcing a tax code that, at 71,000 pages, makes Anna Karenina look like a comic book.

Starting in 2014, the agency will have another task: making sure all Americans have health insurance. Under the law, Americans who can afford health insurance but refuse to buy it will face a fine of up to $695 or 2.5% of their income, whichever is higher. More than 4 million Americans could be subject to penalties of up to $1,000 by 2016 if they fail to obtain health insurance, the Congressional Budget Office said last week.

The IRS will be the enforcer — sort of.

While the IRS can impose liens or levies, seize property or seek jail time against people who don't pay taxes, it’s barred from taking such actions against taxpayers who ignore the insurance mandate. In the arsenal instead: the ability to withhold refunds from taxpayers who decline to pay the penalty, IRS Commissioner Doug Shulman said this month.

Still, compliance with the health reform law will be largely voluntary, says Timothy Jost, a law professor at Washington and Lee University. “By taking criminal sanctions and liens and levies off the table, the IRS’s hands are tied, to a considerable extent.”

The IRS is “being put in a position where it will be sending notices that will annoy people” and not much else, says James Maule, professor of law at Villanova University and author of the tax blog MauledAgain. “It’s basically designed for failure.”

via IRS lacks clout to enforce mandatory health insurance – USATODAY.com.

So according to the jury-rigged, Rube Goldberg provisions of the law, an agency that has a completely different purpose is asked to enforce the law, and then the mechanisms necessary to enforce it are taken away. How can this possibly work?

The salty will lose its savor

The government, through the Food and Drug Administration, is planning to issue regulations with the force of law limiting how much salt products can contain.  The plan is to implement phased reductions of salt so as to gradually wean consumers off of sodium chloride.

The Food and Drug Administration is planning an unprecedented effort to gradually reduce the salt consumed each day by Americans, saying that less sodium in everything from soup to nuts would prevent thousands of deaths from hypertension and heart disease. The initiative, to be launched this year, would eventually lead to the first legal limits on the amount of salt allowed in food products.

The government intends to work with the food industry and health experts to reduce sodium gradually over a period of years to adjust the American palate to a less salty diet, according to FDA sources, who spoke on condition of anonymity because the initiative had not been formally announced.

Officials have not determined the salt limits. In a complicated undertaking, the FDA would analyze the salt in spaghetti sauces, breads and thousands of other products that make up the $600 billion food and beverage market, sources said. Working with food manufacturers, the government would set limits for salt in these categories, designed to gradually ratchet down sodium consumption. The changes would be calibrated so that consumers barely notice the modification.

The legal limits would be open to public comment, but administration officials do not think they need additional authority from Congress.

“This is a 10-year program,” one source said. “This is not rolling off a log. We’re talking about a comprehensive phase-down of a widely used ingredient. We’re talking about embedded tastes in a whole generation of people.”

The FDA, which regulates most processed foods, would be joined in the effort by the U.S. Department of Agriculture, which oversees meat and poultry.

Currently, manufacturers can use as much salt as they like in products because under federal standards, it falls into the category deemed “generally recognized as safe.” Foodmakers are merely required to report the amount on nutrition labels.

But for the past 30 years, health officials have grown increasingly alarmed as salt intake has increased with the explosion in processed foods and restaurant meals. Most adults consume about twice the government’s daily recommended limit, according to the Centers for Disease Control and Prevention. . . .

“We’re working on it voluntarily already,” said Melissa Musiker, senior manager of science policy, nutrition and health at the Grocery Manufacturers Association. In recent months, Conagra, Pepsico, Kraft Foods, General Mills, Sara Lee and others have announced that they would reduce sodium in many of their products. Pepsico has developed a new shape for sodium chloride crystals that the company hopes will allow it to reduce salt by 25 percent in its Lay’s Classic potato chips.

via FDA plans to limit amount of salt allowed in processed foods for health reasons.

Read the rest of it, including the protests from the salt industry, which argues that the more salt we eat, the more salt we excrete. The article also quotes food industry spokesmen who point out problems with cutting the salt out of many products and who observe that low-sodium products just don’t sell all that well. But the marketplace won’t matter. Especially now that the government is in charge of our health.

Doctor shortage

The complicated Rube-Goldberg chain of unintended consequences with our new health care system may be starting:

The new federal health-care law has raised the stakes for hospitals and schools already scrambling to train more doctors.

Experts warn there won’t be enough doctors to treat the millions of people newly insured under the law. At current graduation and training rates, the nation could face a shortage of as many as 150,000 doctors in the next 15 years, according to the Association of American Medical Colleges.

That shortfall is predicted despite a push by teaching hospitals and medical schools to boost the number of U.S. doctors, which now totals about 954,000.

The greatest demand will be for primary-care physicians. These general practitioners, internists, family physicians and pediatricians will have a larger role under the new law, coordinating care for each patient.

The U.S. has 352,908 primary-care doctors now, and the college association estimates that 45,000 more will be needed by 2020. But the number of medical-school students entering family medicine fell more than a quarter between 2002 and 2007.

A shortage of primary-care and other physicians could mean more-limited access to health care and longer wait times for patients.

Proponents of the new health-care law say it does attempt to address the physician shortage. The law offers sweeteners to encourage more people to enter medical professions, and a 10% Medicare pay boost for primary-care doctors.

Meanwhile, a number of new medical schools have opened around the country recently. As of last October, four new medical schools enrolled a total of about 190 students, and 12 medical schools raised the enrollment of first-year students by a total of 150 slots, according to the AAMC. Some 18,000 students entered U.S. medical schools in the fall of 2009, the AAMC says.

But medical colleges and hospitals warn that these efforts will hit a big bottleneck: There is a shortage of medical resident positions. The residency is the minimum three-year period when medical-school graduates train in hospitals and clinics.

There are about 110,000 resident positions in the U.S., according to the AAMC. Teaching hospitals rely heavily on Medicare funding to pay for these slots. In 1997, Congress imposed a cap on funding for medical residencies, which hospitals say has increasingly hurt their ability to expand the number of positions.

Medicare pays $9.1 billion a year to teaching hospitals, which goes toward resident salaries and direct teaching costs, as well as the higher operating costs associated with teaching hospitals, which tend to see the sickest and most costly patients.

Doctors’ groups and medical schools had hoped that the new health-care law, passed in March, would increase the number of funded residency slots, but such a provision didn’t make it into the final bill.

“It will probably take 10 years to even make a dent into the number of doctors that we need out there,” said Atul Grover, the AAMC’s chief advocacy officer.

via U.S. Faces Shortage of Doctors – WSJ.com.

Is the health care law unconstitutional?

An editorial in the Washington Post, no less, which supported the health care reform bill, admits that the lawsuits seeking to strike down the new law may have a case:

Just minutes after Tuesday’s signing ceremony, the constitutionality of the health insurance reform law came under fire. A coalition of attorneys general from 13 states filed suit in a northern Florida federal court; Virginia lodged a separate complaint, and other states may follow.

These challenges are not frivolous. The states argue that the individual mandate — forcing individuals to purchase health insurance — stretches and distorts Congress's constitutional power “to regulate Commerce . . . among the several states.” A person who declines to buy insurance is not engaged in interstate commerce and should therefore lie beyond the reach of Congress, they say.

This contrasts, in two ways, with a consumer who is forced to buy car insurance. First, states have power to regulate activities within their borders that the Constitution does not grant the federal government. Second, a consumer must choose to enter the car market; only then does a state place a condition on that choice by requiring insurance. If the courts acknowledge the legitimacy of the individual mandate, the states argue, the federal government’s power to order purchases of other products or services — or any number of other directives — would be unlimited.

via States argue the feds can’t force purchase of health insurance – washingtonpost.com.

To use an example I’ve heard, if the federal government can compel people to purchase health insurance, it should also be able to decide that it would be beneficial to the national economy to require everyone to buy a GM automobile.

Abstinence funding

The health care reform bill consisted of 1,990 pages.  Congressmen could hardly have read what they were voting for.  Who knows what all is in there?  There may be all kinds of surprises.  For example, to the dismay of many liberals, funding for abstinence education–which Democrats thought they had killed–was stuck into the bill, to the tune of $250 million:

A little-noticed provision of the health legislation has rescued federal support for a controversial form of sex education: teaching youths to remain virgins until marriage.

The bill restores $250 million over five years for states to sponsor programs aimed at preventing pregnancy and sexually transmitted diseases by focusing exclusively on encouraging children and adolescents to avoid sex. The funding provides at least a partial reprieve for the approach, which faced losing all federal support under President Obama’s first two budgets.

via Health bill restores $250 million in abstinence-education funds – washingtonpost.com.

Isn’t it something that teaching children to wait until they get married to have sex is now “controversial”?