News

How do doctors feel about the federal government’s regulation of their profession?

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In the Wall Street Journal, a doctor speaks out about government control of health care.

Excerpt:

In my 23 years as a practicing physician, I’ve learned that the only thing that matters is the doctor-patient relationship. How we interact and treat our patients is the practice of medicine. I acknowledge that there is a problem with the rising cost of health care, but there is also a problem when the individual physician in the trenches does not have a voice in the debate and is being told what to do and how to do it.

[…]The Centers for Medicare and Medicaid Services dictates that we must use an electronic health record (EHR) or be penalized with lower reimbursements in the future. There are “meaningful use” criteria whereby the Centers for Medicare and Medicaid Services tells us as physicians what we need to include in the electronic health record or we will not be subsidized the cost of converting to the electronic system and we will be penalized by lower reimbursements. Across the country, doctors waste precious time filling in unnecessary electronic-record fields just to satisfy a regulatory measure. I personally spend two hours a day dictating and documenting electronic health records just so I can be paid and not face a government audit. Is that the best use of time for a highly trained surgical specialist?

This is not a unique complaint. A study commissioned by the American Medical Association last year and conducted by the RAND Corp. found that “Poor EHR usability, time-consuming data entry, interference with face-to-face patient care, inefficient and less fulfilling work content, inability to exchange health information between EHR products, and degradation of clinical documentation were prominent sources of professional dissatisfaction.”

In addition to the burden of mandated electronic-record entry, doctors also face board recertification in the various medical specialties that has become time-consuming, expensive, imposing and a convenient method for our specialty societies and boards to make money.

Meanwhile, our Medicare and Medicaid reimbursements have significantly declined, let alone kept up with inflation. In orthopedic surgery, for example, Medicare reimbursement for a total knee replacement decreased by about 68% between 1992 and 2010, based on the value of 1992 dollars. How can this be? Don’t doctors have control over what they charge for their services? For the most part, no. Our medical documentation is pored over and insurers and government then determine the appropriate level of reimbursement.

I don’t know about other physicians but I am tired—tired of the mandates, tired of outside interference, tired of anything that unnecessarily interferes with the way I practice medicine. No other profession would put up with this kind of scrutiny and coercion from outside forces. The legal profession would not. The labor unions would not. We as physicians continue to plod along and take care of our patients while those on the outside continue to intrude and interfere with the practice of medicine.

We could change the paradigm. We could as a group elect not to take any insurance, not to accept Medicare—many doctors are already taking these steps—and not to roll over time and time again. We have let nearly everyone trespass on the practice of medicine. Are we better for it? Has it improved quality? Do we have more of a voice at the table or less? Are we as physicians happier or more disgruntled then two years ago? Five years ago? Ten years ago?

Doctors certainly provide a lot more value to me than unions, lawyers and government workers of all sorts. I wish we had more doctors, and fewer unions, lawyers and government workers. Anything that doctors can do to push back against their tormentors would be welcome in my opinion.

 

News

House Committee: only 67 percent of Obamacare enrollees have paid premiums

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From The Weekly Standard.

Excerpt:

Only two-thirds of the eight million enrollees into new health insurance plans as mandated by the Affordable Care Act have paid their first month’s premium as of April 15, according to a report from the House Energy and Commerce committee.

Here’s an excerpt from the committee’s statement:

Data provided to the committee by every insurance provider in the health care law’s Federally Facilitated Marketplace (FFM) shows that, as of April 15, 2014, only 67 percent of individuals and families that had selected a health plan in the federally facilitated marketplace had paid their first month’s premium and therefore completed the enrollment process. Nationwide, only 25 percent of paid enrollees are ages 18 to 34. The Subcommittee on Oversight and Investigations today invited the leaders of some of the nation’s largest insurance providers and their trade groups to testify at a hearing, “PPACA Enrollment and the Insurance Industry,” on Wednesday, May 7, 2014, at 10:15 a.m. in room 2123 Rayburn House Office Building.

House Energy and Commerce Committee members sent letters requesting specific enrollment data, including the number of individuals who have paid their first month’s premium and demographic breakdowns. The committee has compiled the data that provides a snapshot of the true enrollment picture as of April 15, 2014, after the official end of the open enrollment period. Due to the administration’s repeated and unilateral extensions and changes, as well as the fact that many insurers have reported that individuals will still have time to pay their first month’s premium, the committee plans to ask the insurers in the federally facilitated marketplace to provide an enrollment update by May 20, 2014.

Now, remember when Obama went out in front of the eager mainstream media and bragged about how 8 million people signed up? Not one journalist asked him how many people had actually paid for a health care plan. And now we know the truth. But how many of the low-information voters who vote Democrat will read a story like this? They may be struggling with the new health care law, but they’ll think that it’s working for most people because of the mainstream media and the 8-million enrollments claim.

 

Commentary

Why are young evangelicals reluctant to defend Biblical Christianity in public?

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Here’s an interesting post by Mark Tooley in the American Spectator.

Excerpt:

A new generation of evangelical elites is imploring evangelicals to step back from the culture wars. Mostly they want to escape polarizing strong stances on same-sex marriage and abortion, and perhaps also contentious church-state issues, like the Obamacare contraceptive mandate.

Purportedly the evangelical church is failing to reach young, upwardly mobile professionals because evangelicals, who now broadly comprise perhaps one third of all Americans, are seen as reactionary and hateful. On their college campuses, at their coffee shops, and in their yoga classes, among other venues, some outspoken hip young evangelicals want a new public image for their faith.

[…]A popular young evangelical blogger echoing Merritt’s theme is Rachel Evans, who conveniently grew up in the Tennessee small town famous for the Scopes Monkey Trial. Her 2010 book was Evolving in Monkey Town: How a Girl Who Knew All the Answers Learned to Ask the Questions. “We are tired of the culture wars,” she explained in a recent interview. “We are tired of politics.” Lamenting the church’s preoccupation with “shame and guilt,” she urged evangelicals to reconsider their opposition to same-sex unions.

The post has a nice history of how evangelicals have always been involved in moral and political issues, and it’s worth reading. But I want to make a different point below.

Compartmentalization of faith

What’s at the root of this movement to back away from moral issues? Here’s what I think is the problem. When you advocate for moral causes like protecting the unborn, or school choice, or freeing the slaves, a bunch of people are not going to like you. Christians in the time of Jesus knew that being bold about their Christian convictions would make a lot of people think bad things about them – they expected it. But young evangelicals have gotten the idea that being a Christian should not involve any sort of unhappiness and unpopularity. They wouldn’t have learned this from the Bible, because the Bible emphasizes suffering and unpopularity as part of the normal Christian life. It is their experience of church (and the hedonistic culture around them) that is likely to reinforce that view.

What young evangelicals learn in many churches is that religion is something that is centered on the Bible and the church building – it is not something that flows into real life. They learn that you can’t find out anything about God from the Big Bang, the DNA, the fossil record, or even from the peer-reviewed research on abortion, divorce, or gay marriage. They learn from the Bible that helping the poor is good, but then they never pick up an economic textbook to see which economic system really helps the poor. What you learn about in church is that religion is private and has no connection to reality whatsoever. This fits in with their view that Christianity should make them happy, because they’ve learned that it doesn’t involve any studying to connect the Bible to the real world.

What follows from having a view that Christianity only lives in the Bible and church, and not out there in the real world of telescopes and microscopes? Well, most young evangelicals interpret what their pastor is telling them as “our flavor of ice cream” or “our cultural preference”. They don’t link Christianity to the real world, they don’t think that it’s true for everyone. They think that you just accept what the Bible says on faith, and that’s all. No reasons can be given to non-Christians outside of just asking them to accept the Bible. Younger evangelicals believe that there are no facts that confirm or disprove Christianity – it’s just a blind belief. Young evangelicals think that their faith doesn’t have to be complemented with careful study of how things work in the real world.

What is the result of this anti-intellectual compartmentalization of faith? The result is that young evangelicals will balk at the idea of telling someone that they are going to Hell if they don’t believe in Jesus. They will balk at the idea that feminism is to blame for the destruction of the family. They will balk at the idea that the best way to help the poor is to push for free market capitalism. They will balk at the idea that it is wrong to kill unborn children. They will balk at the idea that disarmament and pacifism embolden terrorists and tyrants to attack peace-loving people. They will balk at the idea that traditional marriage is better for society and children. They will balk at the idea that man-made catastrophic global warming is not supported by science. They lack courage to take Biblical positions, because they first lack knowledge. They don’t know how to make the case using evidence that their opponents will accept – mainstream evidence from publicly accessible sources.

Christianity is a knowledge tradition

If the purpose of religion is to have happy feelings and be liked, then studying the real world to find out whether the Bible is true is bad religion. If religion is divorced from reality, then it’s just a personal preference influenced by how a person was raised. No young evangelical is going to lift a finger to take bold moral stands if they think their worldview is just one option among many – like the flavors of ice cream in the frozen section of the grocery store. They have to know that what they are saying is true – then they will be bold. An example: there was a time when people believed that God did not create the first living cell, because it was just a simple lump of protoplasm that could easily come about by accident. Now we know better, and we can boldly make the case for intelligent design based on hard evidence – if we put in the time to study the evidence.

And it is the same for everything – from theological claims, to moral claims, to social claims, to economic claims, to foreign policy claims. It doesn’t matter if people call you names when you have the facts to support unpopular claims, and that’s why public, authentic Christianity is built on knowledge of facts. Non-Christians being offended by your claims doesn’t change the way the world is.