Wednesday, April 29, 2009

I Vaguely Implied To You So!

Megan wants to know if there's a doctor in the house. She hints (but does not link) to an NYT article (presumably this) about a shortage of doctors. She then modestly states "Gee, where have I heard this before?" Luckily, she didn't forget to link to herself.

The link is to a post "Is there a better way?" which attempts to address this comment:

You're a long way from establishing your critical point, focusing only on the downsides of unionism to productivity. What about the downsides of focusing only on the next quarter's return? Any individual corporation would be best served by a return to servitude (company towns, anyone?). The system as a whole may well be better served by having a systematic counterweight to maximizing short-term profits.

Just curious. Are you paid on a piece-work basis or do you draw a salary? Given what you do here, shouldn't you be paid on a piecework basis?

As you think about that, remember that there are other values in this world than maximizing short-term productivity, like treating people with dignity. Who knows, maybe the people who get paid a little more can actually afford to buy the products that the economy generates.
Strangely, it doesn't mention health care at all.

I think she's patting herself on the back for saying this in reply (amongst a host of other "points."):
On the fourth point, this is a silly canard. On an economy level, we cannot produce more by paying workers more, any more than you can increase the height of your house by calling the basement the first floor. The amount of stuff everyone has is determined (more or less) by the productive capacity of the economy. You can redistribute that stuff between people, and you can change the mix of stuff that gets made. But you cannot make more of it by changing the nominal price of labor. The only way to get more stuff as a society is to improve our productive capacity, mostly by research and capital investment.
Which is, of course, total fucking bullshit. If we pay people who do useless shit like being lawyers a shit-ton and our productive members nothing, then we will produce less. Also, she isn't talking about fucking health care. She's stating a simplistic Econ 101 principle that applies TO THE ENTIRE ECONOMY and not A SPECIFIC PROFESSION. Naturally, it bears only a passing relation to the real world like all simplistic Econ 101 principles.

So, this is Megan's life these days. She finds a current topic vaguely relevant to some bullshit econo-crap she has recited previously in an entirely unrelated context and we're all supposed to be like "ZOMG, how does she predict these things?!?!?!??!"

Gather round all and listen to the great Nutstradamus. When you pay CEOs a shit ton of money to account for only stock holder considerations, then they will do things that may cause great harm to non-stock holders. Next time a large corporation cuts a corner and causes significant harm to random people, be sure to check back here to see me saying "Gee, where have I heard that before?"

On to Megan's "points" about health care.
The core problem is that we don't actually have a ton more doctors and nurses. (...) But when I look at the numbers, I don't see all that much room to believe that getting rid of the AMA would let a thousand flowers bloom. In 2008, 42,000 people applied to medical school, and 18,000 enrolled.
Hm, well, I see about 24,000 people's worth of wiggle room, myself. I also see that the focus of the NYT article is a lack of primary care doctors, not total doctors. It briefly mentions a lack of specialists but only cites examples of people having trouble getting access to them in rural areas -- an entirely different story.
Another problem is that a teaching hospital is a hard thing to construct--given how much training doctors need, we won't do that overnight. Teaching hospitals are very expensive, and receive heavy government subsidies. Obviously, we could increase the number of doctors by some amount, but it wouldn't take care of the supply problem.
No! What will we do?! Not "very" expensive and "heavy" government subsidies! That sounds "really" hard! We can only increase doctors by "some" amount! That clearly won't be enough!
It's more reasonable to note that reimbursement structures are creating an undersupply of primary care physicians, compared to the number of specialists.
Right, which is why the article focuses on that. I like how she destroys a strawbaby and then takes her "opponent's" actual argument as her own.
We reimburse for procedures, not wellness, so surgeons are well paid and GPs aren't.
For someone who is an "economist" you'd think she would understand that we always reimburse for "things" rather than "intangible bullshit."
First of all, thanks to previous generations of these reimbursement policies, the AMA is dominated by specialists. It's a democratic organization, and there are more specialists than GPs, so guess who wins? They will launch an all-out war against any politician who changes the reimbursement policy, and the politician will lose, because they can't fight ads featuring sad, sick, telegenic grannies.
Don't you love how when it comes to things like health care she's so pragmatic, always addressing the political reality rather than any flaws in that reality? I love it almost as much as I love how thoroughly she ignores those same realities when talking about things like invading countries, destroying medicare/social security etc.
Second of all, it's actually really, really hard to pay GPs well, at least in the context of cutting overall costs. Note that private insurers, who are presumably not attempting to ingratiate themselves with the AMA, also reimburse procedures, not wellness.
I must be atypically smart because I can think of a million and one things that might be easy to do and involve paying GPs more money. One of them involves handing them some money. The rest are even more complicated. Also, procedures are given more money because they cost more. Specialists take as profit a certain percentage of that higher cost. Naturally they are paid more. This has fuck all to do with "wellness" or "paying for procedures" or whatever. It's a fucking consequence of everything in capitalism. There is more money to be made per capita in high cost goods. Whoops! I'm getting into advanced economics here which is over our poor woman's head.
Pay for office visits, and you will get a lot of unnecessary office visits. As David Cutler once told me, it's no coincidence that health care and education are the two fields where outcomes are hardest to monitor, and where costs are growing uncontrollably.
No, the first is only true if the doctor's are struggling to fill their schedules. If they can already fill them with legitimate office visits, they won't prescribe extraneous ones.

The second is, again, completely irrelevant to the topic at hand. GPs don't provide "more wellness" than other doctors. They just provide different services which aren't be funded as highly.
Nor can you simply slash specialty reimbursements as a way of herding people into general practice, because med school applications are already declining; they're down 3.5% since 2001. Doctors are not, by and large, altruists who dream of living on a GS-13 wage. Nor can I blame them.
But we're only enrolling 40% of applicants, and there are major opportunities for overhauls such as increasing care from less trained workers such as LPNs. As for wages, my father is a psychiatrist; one of the lowest paid branches of medicine. He probably doesn't know what the fuck GS-13 is, but I'm sure he's making more than it. He's not complaining about his pay. Frankly, I'd rather not have doctors around who are in it for the money. If you only care about money, then you will do what is profitable rather than what produces "wellness." Naturally, Megan doesn't blame them for that.


spencer said...

Yeah, I'm not at all interested in handing my health care over to someone who was motivated primarily by money when he or she made the decision to become a doctor.

Since, you know, it might be the case that the best course of treatment for optimizing my health is not the most lucrative for the doctor. My doctor would therefore be motivated to prescribe the lucrative treatment - and I would be in no position to know if it was actually the best choice.

Get it, Megan? Sometimes being "money motivated" (as they sometimes say in those help wanted ads for college students) leads to less than optimal outcomes. Wrap your brain around *that.*

Also, what is a "vagule?"

NutellaonToast said...

Ahg, I always forget to proof my titles. I'm guessing that's where the error was.

Anonymous said...

"Vagule" is a typo of "vaglue" which is a costly OB/GYN procedure.

Susan of Texas said...

Or a very strange type of birth control.

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