Rob Taylor at Red Alerts has a compelling post up about a recent article from the New England Journal of Medicine, concerning a survey conducted sometime before the passage last night of the Senate Health Care Bill by the House of Representatives. What it basically states is that, such a bill will likely result in close to one third of American doctors leaving the medical profession, either taking early retirement or in some cases leaving in the prime of their careers.
It could have been worse. Had the bill contained a public option, of the kind wanted by most Democrats (though not enough of them to overcome Republican opposition) the percentage of doctors leaving the field would be something more like a little more than forty percent. I shudder to think of what it would have been like with single-payer.
When all is said and done, I doubt it will be that bad, at least not at first. Doubtless it will be bad, but I tend to think most doctors are far too tied up in paying off their mortgages and medical school loans to seriously consider walking off the job. At least, not right away. However, somewhere down the road, this could be a possibility, and I have no doubt it could result in as many as ten or even twenty percent of doctors quitting, in many cases precisely because many of them will no longer be able to meet their financial obligations under any scenario.
But it could get even worse. We are talking here about the number of currently practicing physicians who might or might not leave. The most unnerving possibility is later down the line, when enrollment in medical school, and so new entries into the medical profession, takes a steep dive of ten, twenty, even thirty percent or more. Nor is it likely that all of these reductions will be made up by immigrants. In fact, passage of this law will probably reduce those numbers considerably as well. In the meantime, we have a significantly aging and ailing population. Rationed care may well have never been a considered factor or plan in drawing up this bill, but harsh reality might nevertheless make it a foregone conclusion.
There are some things that might be done to stem the tide of defections of currently practicing physicians, things that might not be popular, but may yet be unavoidable. A federal law mandating the ability of doctors to renegotiate the terms of their loan payments and mortgages might be one example. An increase in the number and amounts of student loans, with guaranteed locked in rates of low interest. All of this of course would serve to add to the deficit, and may do little to reduce the numbers of those leaving the medical profession, and more importantly, encouraging new students to enter medical school.
This is going to sour real quick. It would have been a far better approach to work piecemeal toward health care reform. However, that would not have been in the short-term best interests of those who actually control the Democratic congressional majority. This is not just an entitlement, this is or will be a giant, Byzantine structure equal in size and bureaucracy to the largest of cabinet departments. Who will run this thing? How?
By ramming this massive bill through into law, by its nature limited debate. It was intended to discourage transparency, but that proved more difficult than the proponents had hoped. Had they approached the problem one aspect at a time, it would have heightened transparency and allowed more room for substantive debate. Of course, that's the last thing Obama and the Democrats wanted. Had they done that, reform would have looked more like what the people actually wanted. As it stands now, we now are faced with the first case of the federal government mandating that US citizens will now be forced to buy a commercial product, or face fines-possibly jail time.
For this reason, as many as thirty states are in the process of filing suit against the federal government.
We might well be faced before long with the looming of a potential constitutional crisis. We might even see a constitutional amendment somewhere down the road.
It's not over yet.
