"The most economically incompetent administration since the Great Depression"

[Jeremy Roenick]

I have a number of industrial clients and they all laid off large numbers of workers.  NOT ONE is EVER going to return to the previous staffing level even if sales return to pre-2008 levels or grow beyond that.

OMG, this is exactly what we're seeing in the construction industry.  The work has been saddled on the hands present.  No hiring coming any time soon.  Even if work picks up there's a choke point controlled by the number of hands present to do the work.  As a result we're seeing longer lead times in all forms of materials, fabrication and other aspects of construction.

Businesses have figured out how over the last two years to trim the fat (layoffs) and keep a modicum of profits with a smaller cast to do the work.  Sounds like the solution to bloated government doesn't it?

[NCVol]

I also said this.

Sheesh.  Fact is we have a very low ratio of doctors to people in this country.  

I know conservatives prefer to discuss their feelings and hunches, but here are some data on physicians per capita:

# 52      United States:    2.3 per 1,000 people      

Some countries you mentioned with those awful shortages:

= 23      Germany:    3.4 per 1,000 people      
# 17      Switzerland:    3.6 per 1,000 people  
# 25      France:    3.37 per 1,000 people      
= 26      Sweden:    3.3 per 1,000 people      
= 30      Hungary:    3.2 per 1,000 people  
# 41      Ireland:    2.79 per 1,000 people

Two that actually ARE below us:

= 55      United Kingdom:    2.2 per 1,000 people  
# 58      Canada:    2.1 per 1,000 people

You think that's why nearly ALL the horror stories come out of the UK and Canada?  Yeah, I do, they are cherry picking the bottom and pretending that the bottom represents our available options.  

Here's another discussion, from Forbes

But they also fear that any further expansion of government involvement in the health care system will only make it more expensive .....The international data [there's that D word again], however, show no evidence that increasing government's share of health care expenditures raises health spending as a share of GDP. The top five countries with the highest government share of total health outlays spend almost exactly the same percentage of GDP on health as the lowest five countries excluding the U.S.: 8.2% of GDP on average for the former versus 8.3% of GDP for the latter.
...
we have fewer physicians per capita than most other OECD countries: 2.43 per 1,000 population versus an OECD average of 3.1. Austria, Belgium, Iceland, Ireland, the Netherlands and Norway all spend at least a third less of GDP on health than the U.S. yet have almost four doctors per 1,000 population.....Only four OECD countries have fewer acute care hospital beds per capita than the U.S. We have 2.7 per 1,000 population versus an OECD average of 3.8. Japan has 8.2 acute care beds per 1,000 population despite spending half as much of its GDP on health as the U.S. does.
....
Life expectancy at birth is probably the best general measure of a population's health. This statistic has increased by 8.2 years in the U.S. since 1960, but has risen more in most other OECD countries. In Canada, life expectancy has risen 9.4 years and more than 10 years in both Germany and France. Life expectancy rose by almost 15 years in Japan over the same time.
...
In 2006, 6.7 infants died per 1,000 live births in the U.S.--a sharp decline from 26 deaths in 1960. But the infant mortality rate is lower in every other OECD country except Turkey and Mexico.
...
The U.S. does excel at one thing: the amount of highly expensive medical equipment per capita. In 2007, there were 26 MRI machines per 1 million population here versus an OECD average of less than 10. But our lead in high-tech equipment is shrinking. A few years ago we had far more CT scanners per capita than any other country; now our lead is much less and several countries have more scanners per capita.

Here's the deal, legitimate debate is a great thing, but we should be arguing about what the evidence and facts show, and they show we have less access, worse outcomes in many measures, better in others, incredibly high admin costs, and spend roughly twice as much.  Sure, we have at the extremely top end SOME of the best care in the world, but there is simply no evidence we are uniquely superior, and that other countries are lacking skilled surgeons and doctors performing extremely cutting edge procedures for their own populations.  A story or 20 about a King or Prime Minister coming here isn't actually evidence.  We have more hospitals, more doctors, HUGE amounts of money floating around, and so attract some portion of the very best.  That won't change because the government pays PRIVATE hospitals and PRIVATE doctors and PRIVATE drug companies to do what they do now instead of those folks getting a check from United Health or BCBS.  

Seriously, some one explain to me why I care in the least whether Medicare pays my bills or BCBS?  I've never understood it.  Help me out.  I know my mom really doesn't worry that her primary insurer is Medicare.  Why should I?  

[Sasquatch]

Yeah, I do, they are cherry picking the bottom and pretending that the bottom represents our available options.  

Or one could cherry pick the top and pretend the top represents our available options? 

Nah, that would never happen.

I just wonder if any of the other countries' healthcare policies are in violation of their Constitution's like Obamacare has been judged to be?

Oh well, I guess we should just "cherry pick" whatever rulings we like. 

[NCVol]

OMG, this is exactly what we're seeing in the construction industry.  The work has been saddled on the hands present.  No hiring coming any time soon.  Even if work picks up there's a choke point controlled by the number of hands present to do the work.  As a result we're seeing longer lead times in all forms of materials, fabrication and other aspects of construction.

Businesses have figured out how over the last two years to trim the fat (layoffs) and keep a modicum of profits with a smaller cast to do the work.  Sounds like the solution to bloated government doesn't it?

I'm not sure I can buy that.  If there's more work to do than there are people to do it right now at your firm, what's stopping a company from starting up and grabbing a share of the business that's sitting idle?  This is the whole problem with "supply side" economics, that employers provide the demand or that employers "create" jobs.  As far as I can see, the demand for buildings and materials creates the jobs, and employers fill the demand and if your firm or OMG's clients don't do it because they're cautious and don't want to hire ahead of a potential double dip recession, someone else will, especially if the demand remains high enough to maintain long waiting lists.  

It reminds me of these stories of Galtian heroes who will take their ball and go home if they see a tax increase on their estate over $3.5 million, or their first dollar over $250,000.  My response, mostly is, fine, retire, and demand hasn't changed, and so the business that the John Galt wannabee forgoes will shift to some young guy who isn't too worried about how estate taxes will affect his kids since he has no estate, and if someone doesn't care to keep 60 cents per dollar of profit, instead of 65 cents per dollar of profit, he WILL.  

[NCVol]

Or one could cherry pick the top and pretend the top represents our available options? 

Nah, that would never happen.

First of all, I posted my link, go find all those industrialized countries with fewer doctors per 1,000!  The data are there for you to review, go at it.  Prove your point with it.  I'm inviting people to use evidence and data to make their points, but for some reason people prefer stories and talking points.  Why is that? 

And the fact is we CAN learn from what works in the rest of the world.  I'd think, if I was designing a health care reform bill, that I would "cherry pick" from the top systems in the world and tell my staff - THAT is the direction we need to go.  Lower costs, excellent access, excellent outcomes! 

Finally, do a google search for "doctor shortages in U.S."  We have them RIGHT NOW!  One of your stories was about shortages in Germany in rural areas.  Go to a rural area of the U.S.  We got them!  No need to wait for "Obamacare" to kick in - we're already there!  As the data show [damn data - always getting in the way of a good talking point].  In fact, a part of HCR that Bernie Sanders got in there was to open thousands of community health clinics to alleviate some of the access shortages that are ALREADY at crisis levels in many communities.  It's a good thing.  Conservatives should get behind things like that.  As well as incentives to train more primary healthcare givers as opposed to specialists.   

I just wonder if any of the other countries' healthcare policies are in violation of their Constitution's like Obamacare has been judged to be?

Oh well, I guess we should just "cherry pick" whatever rulings we like. 

Well, right now, the federal judges who have ruled are split 2-1-1. Two have ruled it clearly constitutional, 1 ruled the mandate unconstitutional and threw out the entire law, and 1 ruled the mandate unconstitutional and kept all but that - that's the split decision or tie above.  So which side is cherry picking again.... 

[Sasquatch]

First of all, I posted my link, go find all those industrialized countries with fewer doctors per 1,000!  The data are there for you to review, go  No need to wait for "Obamacare" to kick in - we're already there!  As the data show [damn data - always getting in the way of a good talking point]. 

Amen to that! I posted data too, from European doctors and medical groups, which apparently refudiated what was said earlier:

From FL: ...there would be a major shortage of doctors all across Europe. There isn't. Nor will there be in the USA when Obamacare begins.

Now you are saying we already have a shortage of doctors in the US. Doesn't that also refudiate what FL said in regards to there won't be any doctor shortages in the US when Obamacare begins? Or do you believe when it kicks in we can expect a flow INTO the medical profession that will eliminate the shortages? If so, please provide those facts instead of what FL did: OPINION.

I know I am asking a lot (for you to comment on something that left of centers say that contradict what you say), but I would like for you to once at least acknowledge their OPINIONS.

[Jeremy Roenick]

NC, there's not enough work to sustain the contractors in the industry.  If the national unemployment rate is stated around 9 - 10%, in construction it's closer to 30-35%.  That's no exaggeration.  We lost several contractors in 2009 and 2010, but we still have more business to close before the market place is complete in adjusting to the work out there.

The sad thing is that most of the work coming through our office to bid is government or military work.  Thus it's not a reflection of industrial or economic expansion.  It's pure tax-payer funded projects.  The only exception to this is U.T. and the power industry.  U.T. seems to build large, multi-million dollar facilities straight in the face of the poor economy and power is going nuts all over the map.

A good example of the workforce issue in construction right now is the following.  We were awarded a power project in Anchorage, AK late last year.  We're starting to hire job site staff right now.  We placed an ad in the Anchorage newspaper for a site superintendent.  We've received over 400 resumes in just 3 days.  They keep popping up in the email faster than we can print them.

[Sasquatch]

NCVol, I also don't know if you are making an argument for Obamacare or not when you post the doctors per patient ratios. What we see in Europe is long wait times for surgeries and other procedures and they mostly have MORE doctors per patient, according to your data. Think our wait times will decrease or increase when we have the ultimate ends : single payer?

I know this is opinion right now, but I also have historical fact when looking at other systems.

Meantime, I hope you will address my questions in the previous post. Unless you like to cherry pick whose OPINIONS you respond to?  

[NCVol]

Amen to that! I posted data too, from European doctors and medical groups, which apparently refudiated what was said earlier:

From FL: ...there would be a major shortage of doctors all across Europe. There isn't. Nor will there be in the USA when Obamacare begins.

No, you didn't actually post data, you posted a few stories about shortages.  One of them was about Germany, in rural areas.  OK.  We have the same issues no.  Another was France, which defunded medical positions and, predictably, got a shortage.  Both countries STILL have much higher doc/person ratios than we do right now.  

Now you are saying we already have a shortage of doctors in the US. Doesn't that also refudiate what FL said in regards to there won't be any doctor shortages in the US when Obamacare begins? Or do you believe when it kicks in we can expect a flow INTO the medical profession that will eliminate the shortages? If so, please provide those facts instead of what FL did: OPINION.

We do have a shortage of doctors.  Part of it is hidden because we ration care by denying most of it to poor people.  The issue about Obamacare is MILLIONS of people who are rationed out of the market - use the ER for their primary care doctor - will finally get to see a real family doctor.  That's a good thing, but there will be shortages because there are shortages now.  So yes, I disagree with FL on that.  

It's something reasonable people, as well as conservatives  , should get together and work towards a solution.  The HCR bill has some proposals that START the process of addressing the shortage.  I'm waiting on the conservative response.  

And the thing about the number of doctors is it's controlled by the number of slots at medical schools and residencies.  If we increase those, yes we will see a flood of people INTO the profession.  For years the AMA has put a lid on those to maintain a sort of shortage.  Every medical school class is full.  Most residencies are full, and the ones that aren't, according to all the EVIDENCE that I've seen, are those in the primary care field because it pays less.  The "be afraid" thing about doctors taking their balls and going home to the golf course is just about entirely made up.  

There's a poll that I know you've seen that say doctors will all retire in true Galtian fashion if "Obamacare" comes into law, but unfortunately it's highly suspect.  You can read about the issues here, but if they don't offer the questions asked, and don't reveal details of the sample and responses, it's really hard to take a poll seriously.  They're response rate was 6%.  Anyone who has ever done a poll by mail has to demonstrate that such a low response rate didn't color the results.  It might be the 6% were overwhelmingly John Galt I'm-mad-as-hell types and the rest of them didn't bother.  Or not, we don't know, but you have to demonstrate the respondents didn't vary from the population - as step one.  

I sent a request last week to both IBD and their pollster asking for the exact wording of published questions, a description of the population sampled, the sampling method, the dates of interviewing and the response rate. Both the National Council on Public Polls and the American Association for Public Opinion Research mandate disclosure of the first four in all public reports. AAPOR also requires public disclosure of response rates, while NCPP says pollsters should provide them on request. So far, the IBD/TIPP poll fails on all counts.

It's always a clue when someone chooses secrecy over openness on these things.  Why?  

I know I am asking a lot (for you to comment on something that left of centers say that contradict what you say), but I would like for you to once at least acknowledge their OPINIONS.

I think I just did....

[NCVol]

NCVol, I also don't know if you are making an argument for Obamacare or not when you post the doctors per patient ratios. What we see in Europe is long wait times for surgeries and other procedures and they mostly have MORE doctors per patient, according to your data. Think our wait times will decrease or increase when we have the ultimate ends : single payer?

Without Obamacare, we survive with lower doctor/person ratios because we ration care to the poor - they don't get any until they get REALLY sick.  To me, and it's just me, this is a major downside to our system that has 50 million or so without insurance and many more millions with inadequate insurance.  So it's neither an argument for or against Obamacare to point out the implementation issues.  If the GOP plans to increase access with "free market" solutions, their plan will have the SAME ISSUES.  If they want to continue rationing care to the poor, by not providing any until crisis hits, the problem is less severe.  It's really that simple.  

As to Europe, it's not ONE place, it's many places and wait times vary tremendously from place to place.  England is the worst, and the reason is clear - they have HALF the number of docs per person as some of their neighbors and spend about a third what we do per person.  If you chronically underfund something, it should be no surprise you have shortages.  Other countries do BETTER than the U.S. on many measures, including access to primary care physicians, but we clearly rule the world in access to elective surgery and to machinery like MRIs etc. since those make a ton of money for providers, and so wait times are essentially zero for them.  And most of the EU has very good access to non-elective surgeries and procedures, with wait times for most countries extremely good, although England again has some true horror stories.  So you can't say "wait times" without talking about for what, and you can't say "Europe" without telling us WHERE in Europe.  Worldwide, Japan has by the accounts I've seen by far the best record on wait times, with fewer doctors.  Go figure.  Let's see how they do it!  

Here's one study http://www.oecd.org/dataoecd/24/32/5162353.pdf p. 11

The wait times ranged from 13 weeks in Hungary, and 16 in Switzerland, to 42 in the UK and 58 in Portugal.  Generally these are either all surgeries or electives.  Non elective surgeries are typically good in most advanced countries.  

I know this is opinion right now, but I also have historical fact when looking at other systems.

I'm waiting on the facts...  

And BTW, at some point we have to address the trade-offs.  We really can't have it all, and it's just like with other areas of spending, if you can afford to spend double the rate of the rest of the world, some clear advantages will come from that - higher use of cutting edge technology because it is more profitable, outstanding physicians who are drawn to pay levels at the high end several multiples of other countries, near zero wait times for profitable elective surgery.  AND you'll have some downside which is we do basic medicine TERRIBLY - treating asthma, diabetes, chronic heart disease, etc. - those things that are doctor time intensive rather than profitable procedure intensive.  We have terrible records on those measures, because a doctor gets paid a ton for putting you through an MRI, or doing gastric bypass surgery, and not much at all for talking to you about how to control your weight with diet and exercise, etc.  

[Sasquatch]

Here's one study http://www.oecd.org/dataoecd/24/32/5162353.pdf p. 11

The wait times ranged from 13 weeks in Hungary, and 16 in Switzerland, to 42 in the UK and 58 in Portugal.  Generally these are either all surgeries or electives.  Non elective surgeries are typically good in most advanced countries.  

I'm waiting on the facts...  

Uhhhh, didn't you just post "one study" that addresses what I said was historical fact: Waiting time for procedures, surgeries, etc.?

If you don't believe your own facts, here are some more:

Report on Criteria for the management of waiting lists and waiting times in health care

http://www.coe.int/T/DG3/Health/waitinglistreport_en.asp

[NCVol]

I agree wait times are a problem, and we have some issues with that as well in regions, and we have access issues more broadly because of lack of insurance - the uninsured don't GET ON the waiting lists, for example.

And I fully recognize, said so in a couple of ways, that Obamacare will bring a shortage of doctors.  What I also said was it's because we ration care and any plan that increases access - decreases rationing for the poor - will experience shortages, and the answer isn't to talk about the shortage, but talk about how we FIX the problem that we already have. 

Yes, we do great on waits for profitable elective surgery.  Fine.  It's on the positive side.  There's a lot on the negative side.  We have to weigh all those and make some trade offs because we simply cannot go down the same road - it was disastrous. 

And really, if the GOP wants to end Obamacare, go for it.  Propose a plan, let's evaluate it and if it's better, I'll jump on board.  But they voted on repeal with "nothing" as the genius plan to replace it with, and last plan they proposed that had enough detail to actually be evaluated was found to basically do NOTHING for the uninsured, or access or affordability.  But I'm open, seriously, to other options.  Obamacare is FULL of problems, but so is the status quo and the GOP has talking points or "nothing" as their alternative plan.  Life gets harder when you put facts down that can be fully evaluated, you know, an actual plan.  I think they're learning that now with the budget too.  It's easy to talk about cutting $100 billion, much harder to actually CUT $100 billlion.