News

Doctor shortage: how Obamacare makes it harder to find a doctor

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Remember how Obama promised that if you liked your doctor, then you could keep your doctor? It turns out that there is more to making policies than just saying what you’d like to do in a scripted campaign speech. The truth is that some health care policies will make you lose your doctor, regardless of what the President reads off of a teleprompter. Is Obamacare one of these policies? Let’s see.

Avik Roy writes about it in Forbes magazine.

Excerpt:

On Saturday, the Wall Street Journal reported that, due to Obamacare’s cuts to Medicare Advantage, among other factors, UnitedHealth expects its network of physicians “to be 85 percent to 90 percent of its current size by the end of 2014.” The result? Some retirees enrolled in Medicare Advantage will need to find new doctors. And it’s a trend that could accelerate in future years.

[…]Over the next ten years, Obamacare was designed to spend around $1.9 trillion on expanding health coverage to the uninsured. The law pays for this new spending with $1.2 trillion in new taxes, and $716 billion in cuts to Medicare, relative to prior law.

[…]The private insurers who supply Medicare Advantage plans, like UnitedHealth and Humana, have been responding to the cuts by squeezing out inefficiencies in the way they deliver care. One obvious way to do that is to pay doctors and hospitals less—or kick out the providers who refuse to accept lower reimbursement rates. And that’s what United has done, according to the WSJ report from Melinda Beck.

“Doctors in at least 10 states have received termination letters, some citing ‘significant changes and pressures in the health-care environment,’” writes Beck.

Another one of my favorite health care policy experts is the ex-Canadian Sally C. Pipes, who knows all about the horrors of single-payer health care. It killed her mother! Here’s what she had to say about the doctors shortage in a Forbes magazine article from earlier this year.

The first problem is that we have an aging doctor population and since we do such a poor job of educating our children (public school indoctrination centers) we aren’t making any new ones:

Right now, the United States is short some 20,000 doctors, according to the Association of American Medical Colleges. The shortage could quintuple over the next decade, thanks to the aging of the American population — and the aging and consequent retirement of many physicians. Nearly half of the 800,000-plus doctors in the United States are over the age of 50.

The second problem is that adding more regulations and burdensome paperwork makes a lot of people not want to be doctors any more:

Obamacare is further thinning the doctor corps. A Physicians Foundation survey of 13,000 doctors found that 60 percent of doctors would retire today if they could, up from 45 percent before the law passed.

The third problem is that the government isn’t reimbursing doctors as much as private insurance companies do, and it makes them refuse to take government-funded patients:

They’ve long limited the number of Medicaid patients they’ll treat, thanks to the program’s low reimbursement rates. According to a study published in Health Affairs, only 69 percent of doctors accepted new Medicaid patients in 2011. In Florida, just 59 percent do so. And a survey by the Texas Medical Association of doctors in the Lone Star State found that 68 percent either limit or refuse to take new Medicaid patients.

Medicaid pays about 60 percent as much as private insurance. For many doctors, the costs of treating someone on Medicaid are higher than what the government will pay them.

These underpayments have grown worse over time, as cash-strapped states have tried to rein in spending on Medicaid. Ohio hasn’t increased payments to doctors in three years; Kentucky hasn’t raised them in two decades. Colorado, Nebraska, South Carolina, Arizona, Oregon, and Arizona all cut payments in 2011.

By throwing nine million more people into the program without fixing this fatal flaw, Obamacare will make it even harder for Medicaid patients to find doctors.

It’s not just Medicaid that’s the problem, either. It’s the government-controlled exchanges.

Healthcare providers are signaling that they may turn away patients who purchase insurance through the exchanges, too.

In California, for example, folks covered by Blue Shield’s exchange plan will have access to about a third of its physician network. The UCLA Medical Center and its doctors are available to customers of just one plan for sale through the state exchange, Covered California. And the prestigious Cedars-Sinai Medical Center is not taking anyone with exchange insurance.

Now I know what you’re thinking – why not just force doctors to work for lower wages, like a good socialist country might? Well, that actually makes the shortage worse, because people don’t like to learn hard things and then work hard for little pay. And doctors work VERY hard – it’s not an easy profession to get into. That will just make all the doctors leave the country for other countries where they can be paid fairly for the work they do.

And in fact that is exactly what happened in a 100% socialized health care system in Venezuela, according to this report from the left-leaning Associated Press.

Excerpt:

Half the public health system’s doctors quit under Chavez, and half of those moved abroad, Natera said.

Now, support staff is leaving, too, victim of a wage crunch as wages across the economy fail to keep up with inflation.

At the Caracas blood bank, Lopez said 62 nurses have quit so far this year along with half the lab staff. It now can take donations only on weekday mornings.

I recommend reading that entire article for a glimpse of where the Democrats are trying to take us. There is not a dime’s worth of difference on policy between the Democrat party and the socialist party of Venezuela, except that the socialists have been in control in Venezuela for longer, and so they are further along the road to serfdom.

In other news, the Washington D.C. insurance commissioner was fired after raising concerns about the “fix” proposed by Obama in his speech last week. That’s also something that you might expect to see in a country like Venezuela. That’s what happens in authoritarian socialist countries. Whistleblowers and critics just disappear.

News

J. Warner Wallace: practical advice on becoming an effective one-dollar apologist

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As promised, below is my summary of J. Warner Wallace’s most recent Please Convince Me podcast, and my comments.

Details:

J. Warner continues examining the Christian life in light of God’s desire for all of us to become Christian Case Makers. Jim reads listener email highlighting some of the typical frustrations involved in starting an apologetics ministry and then provides a template to help you become the Case Maker you’ve always wanted to be. Jim also answers the question: Why Didn’t Jesus Reveal Scientific Facts to Demonstrate His Deity?

You can grab the MP3 file here.

This episode is probably one of the best episodes of the Please Convince Me podcast I’ve ever heard, because it’s practical. I like listening to the cold-case detective talk about practical things.

Summary:

  • e-mail from someone trying to start an apologetics ministry for college students and facing difficulties
  • the challenge of getting Christians to take an evidential approach to their faith
  • tips for getting Christians exposed to apologetics materials
  • there are a lot of Christians who are making a daily contribution to apologetics even with a full-time job
  • Wallace himself started his apologetics ministry while working full-time
  • Wallace, as an atheist, was initially skeptical of religion because he thought it was too focused on money
  • His plan as an apologist was to take money right out of it – do it for free, and  be self-funded
  • 1 Cor 9: “But I have made no use of any of these rights, nor am I writing these things to secure any such provision.”
  • People in ministry deserve to be supported, but Paul dispensed with that right to raise support for his ministry
  • Paul self-financed his ministry in order to avoid all appearance of doing his ministry for financial gain
  • Similarly, Wallace’s goal of being self-financed was to avoid the appearance of doing ministry for money
  • If you plan your life carefully enough in the first half, you’ll have the money you need to do ministry in the second half
  • Wallace wanted the liberty to pursue things without any financial need, and he achieved this by working full-time
  • The problem with money is that it often causes us to not cooperate well with other people
  • Ministries and churches sometimes avoid working with other people, like scholars and apologists
  • They do this because they are afraid of losing their own people to these scholars and apologists
  • Wallace wants to get the money out of it and be able to serve anyone with a need
  • Wallace: you need to work hard in the first half of life, in order to have freedom to serve in the second half
  • First area: financial preparation – you need to escape financial needs so that it doesn’t restrict your passion
  • Wallace married well, to a woman who was a good saver, very frugal, and not materialistic – he saved 30% of his income
  • Second area: need to prepare yourself educationally for being able to teach apologetics materially
  • That doesn’t always mean doing the MA in apologetics, but you do have master the material – continuous learning
  • Third area: try to focus on the parts of your career that might have some connection to apologetics
  • You want to have experiences in your work where you learn something that can be used in your ministry
  • Wallace actually made career choices to focus on evidence, case-making and teaching
  • It’s hard because men are naturally competitive – we focus on promotions, money and consumer goods
  • It’s not always the right move in your career to get promoted if it takes you away from skills related to apologetics
  • Christian apologists need to not neglect to develop leadership skills and to develop influence
  • He recommends a book called “Platform” by Michael Hyatt, which Doug Groothuis also recommended to me
  • If you are financially independent, then if an unpaid opportunity arises, you have the freedom to take it
  • You can volunteer for positions that you want to have, instead having to take what pays
  • Wallace writes for Breakpoint, and he is able to dispense with the 1000-word limit that gets a fee
  • Money opens up the danger of corruption, so it’s another reason to just take it out of the picture
  • You can be very effective in your apologetics ministry while still working full-time
  • The second half is a good time to have even more freedom because your kids are grown up
  • A good wife can really help you if she is picking up the slack so that you can work on your ministry
  • Jane Pantig works for Ratio Christi, an organization that promotes apologetics on campus
  • Jane’s model: she is in full-time ministry, with a BS in biology and an MA in apologetics (Biola)
  • Jane is able to get many high-quality speakers to speak for free/cheap at San Jose State University

The rest of the podcast deals a question that was asked at the San Jose State University event that Wallace did for Ratio Christi. I blogged about it this morning. I  laughed my butt off while listening to that podcast, starting at around 62:50 and on. It’s pretty funny when he does the role-pay between Jesus and the people listening to him.

My comments:

The reason I wanted to post this is because I think that a lot of people feel obligated to quit their jobs and raise support because they think that you have to do apologetics full time. It’s not true. Wallace explains that he worked as a cold-case detective until just recently when he took his pension. His pension is now underwriting his ministry. Similarly with me, I work a full-time job and run the blog out of my income. In addition, I probably donate a few thousand dollars each year to people who are organizing apologetics lectures, debates and conferences – events featuring speakers I like best.

This blog gets about 1 million page views per year, depending on the year (election years are better), so that’s not an insignificant impact. In addition, I meet a lot of young Christians in university in different countries who want advice or mentoring, so I spend a few hours here and there mentoring them, and sometimes sending them rewards (books) for doing difficult degrees at good universities and getting good grades. My full-time job helps me to do all of these things. And before I could have a full-time job in information technology, I had to put in the time and effort to get the Bachelor and Masters degree in computer science.

So I think that Christian men especially need to be thinking about how much the apologetics enterprise of a one-dollar apologist relies on money. We really need to be thinking about that early on, in high school, and choosing to study hard things and to do well in those hard subjects. The higher-paying jobs that are more secure tend to be in fields like science, math, technology and engineering. We need to be thinking of doing these courses in high school – especially the men, but also the women – in order to be able to pay for our apologetics ministry. In addition, my decision to not marry (unless I meet a woman who can support me in my plan) gives me even more freedom to work on my ministry while working full time.

I fully approve of what Wallace said about self-financing your apologetics ministry – and supporting other apologetics ministries – in order to avoid all appearance of self-interest. In fact, I have long admired Wallace for his intentional, practical way of doing his ministry. He doesn’t take donations, and he gives away tons of materials for free. I like that.

Commentary

J. Warner Wallace: why didn’t Jesus reveal scientific facts to prove his divinity?

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I was listening to J. Warner Wallace’s latest podcast and he mentioned this Cold Case Christianity post because it is getting a lot of attention.

Excerpt:

Last Wednesday I had the opportunity to defend the reliability of the New Testament Gospels to the students of San Jose State University. Jane Pantig (the director of the local Ratio Christi chapter) invited me, and I was delighted to come. I’ve been working with Ratio Christi across the country to defend the Christian worldview on college campuses. If you aren’t acquainted with the work of this growing apologetics movement, you really ought to familiarize yourself with Ratio Christi and find a way to support their efforts. At the end of my presentation, during the question and answer period, a polite young skeptic asked why Jesus didn’t reveal scientific facts in an effort to demonstrate His Deity. Why didn’t Jesus describe something well beyond the scope and knowledge of His contemporaries as a prophetic proof? He could easily have described the role of DNA, the proper organization of the Solar System, or the biological complexity of cellular structures.  The questioner believed this sort of knowledge would have been persuasive to him as a 21st Century skeptic, and without it, he remained unconvinced.

I thought this was a great question, and one I often receive but seldom talk about on the podcast or here on the blog. There are a number of problems with this expectation of superior anachronistic scientific wisdom…

Here’s one of the problems that he mentioned in the post (there are three):

The Nature of the Ancient Audience

The context of Jesus’ ministry and message were defined by the nature (and limitations) of this ancient audience. Sometimes it’s easy for us to approach the gospels from our 21st Century perspective (bringing our desires, needs and expectations to the text), rather than examining them from the perspective of the first hearers and readers. In order to illustrate this point, imagine yourself as Jesus. You’ve got three years to demonstrate your Divinity to those you live with in the 1st Century. Think about what approach you might take. You could reveal yet unknown scientific facts to your audience, but would this accomplish your goal? If you describe the role of DNA or the anatomy of the solar system, how would your 1st Century audience confirm your statements? Surely claims of this nature would be unimpressive to a world without the ability to assess their veracity. In fact, any combination of such claims with other demonstrations of Deity would only serve to dilute the power of your message. There are ways you could establish your Deity in front of such a 1st Century audience, but obscure, esoteric claims are perhaps the least effective approach.

What do you think? Do you think that Jesus should have explained scientific things? Would that work better than what he actually did?

One of the things that this post made me think of is the use of sledgehammer apologetics by Jesus. I know a lot of people who really resent the idea of apologetics, and want us to just read the Bible to people and hope they are magically convinced by just hearing Scripture. But Jesus was not willing to do that. He didn’t just express opinions or give moral teachings or recite poetry. He was in the business of making his case to people, and for evidence he used miracles.

The Sign of Jonah

Professor Clay Jones of Biola University makes the case that the use of evidence when preaching the gospel was standard operating procedure in the early church.

Intro:

In 1993 I started working for Simon Greenleaf University (now Trinity Law School) which offered an M.A. in Christian apologetics (Craig Hazen was the director). Much of my job was to promote the school and although I had studied Christian apologetics since my sophomore year in high school, I decided I needed to see whether an apologetic witness had strong Biblical precedence.

It does.

As I poured through the Scripture I found that Jesus and the apostles preached the resurrection of Christ as the sign of the truth of Christianity.

What follows are some of the passages which support the resurrection witness.

Here is my favorite verse from his massive list list of verses in favor of the evidential approach to Christian apologetics:

Mat. 12:39-40: A wicked and adulterous generation asks for a miraculous sign! But none will be given it except the sign of the prophet Jonah. For as Jonah was three days and three nights in the belly of a huge fish, so the Son of Man will be three days and three nights in the heart of the earth.

Jesus is saying that the resurrection was deliberately given as a sign to unbelievers to convince them. (“The Sign of Jonah” = the resurrection)

The healing of the paralytic

Consider this article from apologist Greg Koukl of Stand to Reason.

Koukl cites three Biblical examples to support the idea that faith is not blind leap-of-faith wishing, but is based on evidence.

Here’s number two:

[I]n Mark 2 you see Jesus preaching in a house, and you know the story where they take the roof off and let the paralytic down through the roof. Jesus said, “Your sins are forgiven.” And people get bugged because how can anyone forgive sins but God alone?Jesus understood what they were thinking and He said this: What’s harder to say, your sins are forgiven, or to rise, take up your pallet and go home?Now, I’ll tell you what would be harder for me to say : Arise, take up your pallet and go home. I can walk into any Bible study and say your sins are forgiven and nobody is going to know if I know what I am talking about or not. But if I lay hands on somebody in a wheelchair and I say, Take up your wheelchair and go home, and they sit there, I look pretty dumb because everyone knows nothing happened.But Jesus adds this. He says, “In order that you may know that the Son of Man has the power and authority to forgive sins, I say to you, arise, take up your pallet and go home.” And he got up and he got out. Notice the phrase “In order that you may know”.

So, I see that God uses nature and miracles to persuade, which can be assessed using scientific (e.g. – fine-tuning) and historical methods (minimal facts case for the resurrection). I think if Jesus had explained DNA and the Big Bang to the first century people, that would not have worked as well as the kinds of things he actually did.

I really want you guys to look through the Bible and see Jesus’ approach to convincing people. You should read the gospel of John to see how Jesus uses miracles to get people to believe that he was who he said he was. This is was his whole modus operandi. Today, none of us can do miracles on demand to convince people – at least I can’t. But that’s why we can use the evidence from science for miracles in nature, like the cosmic fine-tuning and the origin of biological information. And the resurrection is still a good historical argument to make, as well.

I’m going to be summarizing the podcast where Wallace mentioned this question in my 6 PM post, and I urge you to listen to it with my summary at hand. When he was talking about this question, his response made me laugh out loud at what people would think if Jesus had started explaining the fine-tuning argument or the Cambrian explosion. He’s very reserved in this post, but in the podcast he is pretty funny when he role-plays how the first-century people would respond.