Obamacare to create Great Doctor Shortages, Long Wait Times and Rationing of Health Care Services

Posted by PITHOCRATES - November 30th, 2013

Week in Review

How did African slavery arrive to the new world?  The New World was vast continents.  And there were just not enough settlers to farm on the scale required.  With a huge shortage of laborers the colonial powers tried enslaving the local population.  But it proved difficult to keep them enslaved.  As they were well familiar with the land.  And the indigenous population.  If they escaped they could disappear into the land and into the indigenous population.  Something an African slave could not do as well.  If at all.  Strangers in a strange land.  Unable to communicate with the indigenous population.  And unable to hide among them.  Who were probably just as hostile to them as they were to the white man taking their land.  Making escape from bondage much more difficult for the African slave than it was for the indigenous slave.  So the African slave proved to be a good fit for the colonial powers.  Allowing them to fill the shortage of labor by forcing the black man into bondage.  To provide their labor against their will to meet the demand of the ruling colonial powers.

Now there is a new demand that the government will struggle to meet (see Lack of Doctors May Worsen as Millions Join Medicaid Rolls by ABBY GOODNOUGH posted 11/28/2013 on The New York Times).

Dr. Ted Mazer is one of the few ear, nose and throat specialists in this region who treat low-income people on Medicaid, so many of his patients travel long distances to see him.

But now, as California’s Medicaid program is preparing for a major expansion under President Obama’s health care law, Dr. Mazer says he cannot accept additional patients under the government insurance program for a simple reason: it does not pay enough…

His view is shared by many doctors around the country. Medicaid for years has struggled with a shortage of doctors willing to accept its low reimbursement rates and red tape, forcing many patients to wait for care, particularly from specialists like Dr. Mazer.

Yet in just five weeks, millions of additional Americans will be covered by the program, many of them older people with an array of health problems. The Congressional Budget Office predicts that nine million people will gain coverage through Medicaid next year alone. In many of the 26 states expanding the program, the newly eligible have been flocking to sign up…

In California, with the nation’s largest Medicaid population, many doctors say they are already overwhelmed and unable to take on more low-income patients. Dr. Hector Flores, a primary care doctor in East Los Angeles whose practice has 26,000 patients, more than a third of whom are on Medicaid, said he could accommodate an additional 1,000 Medicaid patients at most.

“There could easily be 10,000 patients looking for us and we’re just not going to be able to serve them,” said Dr. Flores, who is also chairman of the family medicine department at White Memorial Medical Center in Los Angeles…

The health care law seeks to diminish any access problem by allowing for a two-year increase in the Medicaid payment rate for primary care doctors, set to expire at the end of 2014. The average increase is 73 percent, bringing Medicaid rates to the level of Medicare rates for these doctors.

But states have been slow to put the pay increase into effect, experts say, and because of the delay and the fact that the increase is temporary, fewer doctors than hoped have joined the ranks of those accepting Medicaid patients. “There’s been a lot of confusion and a really slow rollout,” Ms. Folberg said, “which unfortunately mitigated some of the positive effects…”

Dr. Paul Urrea, an ophthalmologist in Monterey Park, said he was skeptical of “blue-sky scenarios” suggesting that all new enrollees would have access to care. “Having been in the trenches with Medi-Cal patients who have serious eye problems,” he said, “I can tell you it’s very, very hard to get them in to see those specialists.”

Dr. Urrea said that when he recently tried to refer a Medicaid patient with a cornea infection to another eye specialist, he was initially informed that the specialist could not see the patient until February. “And this is a potentially blinding condition,” he added.

Travel long distances to see a doctor?  Long wait times?  A shortage of health care providers?  Low reimbursement rates?  Overwhelmed doctors?  A shortage of specialists?  You’d think your were reading about the UK’s National Health Service (NHS).  But this is just what the Affordable Care Act (aka Obamacare) is doing to Medicaid.  Which it will soon do to the rest of the American health care system.

So not only is the Affordable Care Act making health insurance unaffordable it will create doctor shortages that will lead to longer wait times.  Some waits stretching out over two months.  A wait so long that a patient may go blind from a treatable eye infection.  This is national health care.  People succumbing to their diseases as they wait for treatment that is being rationed out.  Which they have to ration as the number of patients far outnumber the number of doctors available to treat these patients.

So this is what Obamacare will do to the American health care system.  Give us longer waiting times.  Rationed care.  And people succumbing to their illnesses because of the long wait to see a doctor.  Funny as the Afford Care Act was to give affordable health insurance to all.  So everyone could live in a utopia where if they were sick they could go to a doctor and have everything covered.  Just pray you’re not one of those who can’t afford to pay the higher premiums and higher deductibles of Obamacare.  Because these people are being dumped into the overcrowded and underfunded states’ Medicaid systems.  Which will only get worse under Obamacare.  Especially with doctors leaving the Medicaid system.  Retiring early.  Or moving into concierge medicine.  Leaving ever fewer health care providers to tend to the swollen Medicaid ranks.

Not a good time to be a doctor.  For you have to be wary of a government that can’t find enough doctors to voluntarily meet the health care demand.  Especially one that has a Senate ‘rubber-stamp’ for its judicial appointments.  Thanks to Harry Reid and the nuclear option.  Changing the rules of the Senate by eliminating the filibuster for judicial appointments.  Which opens the door for a lot of illegal and unconstitutional law.  Such as new health care mandates issued by the executive branch that exceed its constitutional authority.  Which will be challenged.  But once these cases hit these Obama-packed courts you can guess the outcome.  Illegal and unconstitutional mandates will become law.  Which no doubt concern doctors in a health care system that has a doctor shortage and an explosion of new patients.

If a doctor wants to remain a doctor and get paid for his or her services he or she may find new requirements.  Such as mandatory salary caps.  Forced acceptance of Medicaid patients.  With ‘opting out’ made illegal.  Compelling doctors to work against their will.  Now forcing people to work against their will is nothing new.  When Roman taxes rose so high to pay for the bloated Roman state people quit their jobs to avoid paying taxes.  Then the Roman state made that illegal.  Bonding these people to their jobs.  And when they died their children were forced to continue in their place.  Giving Europe feudalism.  Where the masses worked the land against their will.  For the law prevented them from ever leaving the land they or any of their progeny were born on.  Could this happen to the American health care system?  If the state controls the health care industry and the courts, yes.  Which is why it is not a good time to be a doctor.

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Division of Labor

Posted by PITHOCRATES - November 4th, 2013

Economics 101

(Originally published October 24th, 2011)

The Division of Labor gives us our Houses, Food, Cars, Televisions, Smartphones, Laptops and the Internet

We can’t do everything ourselves.  It’s not efficient.  And most times not even possible.  We don’t build our own houses.  Grow our own food.  Build our own cars.  Manufacture our own high-definition televisions.  Smartphones.  Laptops.  And we don’t build our own Internet.  No.  Instead, people everywhere across the economy specialize in one thing (i.e., work for a living).  And together these specialists fit into the big economic picture.  Which gives us our houses, food, cars, televisions, smartphones, laptops and the Internet.

It started with the most basic division of labor.  Prehistoric women raised their young.  While prehistoric man hunted.  Which was necessary for the propagation of the species.  And us.  For if they all hunted and no one nursed the young the young would have died.  And with them the species of man.  For there was no formula back then.

The next great leap forward on the civilization timeline was the indispensible plough.  The prime mover of civilization.  With the food problem managed, famines were more the exception than the rule.  And with fewer people needed to produce a food surplus, people could do other things.  And they did.

The Division of Labor let us Create Surpluses in Food, Ploughs, Shoes, Tools, Harnesses, Etc.

The division of labor gave rise to artisans.  The first skilled trades.  Made possible by a food surplus.  As other people grew the food the artisans made the tools and crafts the farmers used.  They specialized in plough making and designed and built better and better ploughs.  Lots of them.  Shoemakers made shoes.  Lots of them.  Metal workers made tools.  Lots of them.  Leatherworkers made harnesses.  Lots of them.  See the pattern?

The food surplus gave us surpluses in ploughs, shoes, tools, harnesses, etc.  The division of labor let us create these surpluses.  Specialists made continual improvements in their areas of specialization.  Producing better things.  And more of them.  Which led to another key to the advanced civilization.  Trade.

The shoemaker didn’t have to grow food.  He could trade shoes for food.  Ditto for the plough maker.  The metal worker.  The leatherworker.  And the farmers didn’t have to make any of these things because they could trade food for them.  So we became traders.  We created the market.  And traders took their goods and/or services to these markets to trade for other goods and/or services.  First by foot.  Then by animal.  Then by boat.  Then by train.  Then by truck.  Then by airplane.  Artisans (i.e., workers) traded their specialization for the product and/or services of another’s specialization.  Then.  And now.

The Division of Labor made the Complex Simple and our Lives Rather Comfortable and Fun

The division of labor gave rise to the artisan.  The skilled trade worker.  The middle class.  People who can specialize in one thing.  And trade that one thing for the other things he or she wants.  Whether it be a skilled blacksmith hammering out farming tools.  A tool and die maker working in a factory.  An accountant.  Or a software engineer.  We have a skill.  Our human capital.  And we trade that skill to get the other things we’re not skilled in.  The end result is a modern, bustling, free market economy.  An advanced civilization.  And a high standard of living.

All thanks to the division of labor.  Which made the complex simple.  And our lives rather comfortable.  And fun.  Unlike prehistoric man.  Who knew of no such things as iPhones.  Indoor flush toilets.  Movie theaters.  Or restaurants.  No, he didn’t do much other than survive.  Which was no easy thing.  But he did.  And for that we are grateful.

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Money

Posted by PITHOCRATES - November 7th, 2011

Economics 101

The High Search Costs of the Barter System Hindered Trade

Agriculture advances gave us food surpluses.  Food surpluses gave us a division of labor.  The division of labor gave us trade.  And trade gave us an advanced civilization.  By allowing more specialists to live together in crowded urban settings.  Creating a rich surplus of goods for trade.  That people traded.  With other people.  Near.  And far.

As trade grew civilizations got better.  The division of labor grew larger.  And more complex.  Producing more things.  Soon there was a rich variety of goods to trade with for other goods.  From civilizations in distant lands.  Which made life more interesting.  And enjoyable.  During that brief time when you weren’t working.  Or trading.  Which was taking more and more time.  To find someone to trade with.  That had something you wanted.  And who wanted something you had.

This is the barter system.  Trading goods for goods.  Producers took their goods to other producers.  And asked, “What will you take in trade for that?”  Often the response was, “Nothing that you have.”  To which the trader replied, “Very well.  I shall keep looking.”  And sometimes would spend days, weeks and even months looking.  And that was time spent not making anything new.  This was the high search cost of the barter system.  And it hindered trade.  We needed something better.

Money made Trade more Efficient and Unleashed the Human Capital of the Middle Class

For civilization to advance further we had to make trade more efficient.  We had to reduce these search costs.  What we needed was a temporary storage of value.  Something we could trade our valuable goods for.  And then trade the value of our goods, held temporarily in this temporary storage of value, for something else of value later.  And we call this temporary storage of value money.

Money greatly simplified things.  Allowed a more complex economy.  A greater division of labor.  And it allowed wages.  Allowing more people to work on more narrow specialties.  These producers could then take their wages to market.  And buy what they needed.  Instead of spending days, weeks or even months traveling to find people to barter with.

Money made trade more efficient.  It allowed cities to grow in size.  And become even more advanced.  It unleashed the human capital of the middle class.  For they could spend more time creating and building new and better things to trade.  And this economic activity allowed more people to live together peacefully.  As producers produced.  And traded with other producers.  All made easier by money.  A temporary storage of value.

Money doesn’t Create or Produce, it just Temporarily Stores the Value of what we Create and Produce

Please note what came first here.  First there was trade.  Then there was money to make that trade more efficient.

At the heart of all economic activity is our human capital.  What we use to create and produce.  Money doesn’t create or produce.  It just stores the value of what we create and produce.  Which is why Keynesian economic stimulus doesn’t work.  Making money to give to people to spend simply does not create new economic activity.

Our skills create economic activity.  That ability to create things other people value.  And wish to trade for.  Because we are traders.  Not spenders.  We trade things of value.  And to trade things of value someone has to create them first.  If you just take things of value without offering something of value in trade it is not trade.  It’s plunder.  And little different from the uncivilized barbarians on the frontier of the civilized world.

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Trade

Posted by PITHOCRATES - October 31st, 2011

Economics 101

People Traded the Things they Made to have Things they couldn’t Make

Agricultural advances gave us food surpluses.  Food surpluses gave us the division of labor.  And spare time.  For the first time everyone didn’t have to hunt or gather food.  They could do other things.  Think.  Experiment.  Innovate.  Create.  And they did.  Becoming specialists.  A middle class.  Artisans.  People who became very good at doing one thing.  So they kept doing that one thing.  Finding ways to improve that one thing.  And created surpluses of their own.  Potters made excess pottery.  Shoemakers made excess shoes.  Tanners made excess leather goods.  Metalworkers made excess metal goods.

Cities grew in the center of the sprawling farmland.  And it was in the cities where these artisans lived.  Where they honed their specialties.  And met.  With other specialists.  And with farmers.  To trade.  The potter would trade pottery for shoes.  The farmer would trade food for shoes and metal goods.  The tanner would trade leather goods for pottery, shoes and food.  And so on.  People traded the things they made.  To have things they couldn’t make.  Everyone was able to have more things.  Thanks to this trade.

This unleashed the vast human capital of the people.  Their cities.  And their civilization.  Cities on the coast fished.  Cities closer to the forest harvested wood.  Cities closer to the hills mined silver, gold and copper.  And coal.  And the cities traded their surpluses with other cities.  Metal workers and potters traded their goods for fuel for their forges and kilns.  Miners traded their ore and coal for grain and fish.  Either directly.  Or indirectly.  When other people traded their large surpluses with other people in other cities.  With the miners getting a portion of these large-scale trades for all their efforts to make those trades possible.

As Civilizations became more Complex they became more Dependent on Trade

All of this trading made cities grow.  And as a result the civilization they belonged to grew.  And became more advanced.  People ventured further.  Looking for other resources.  And met people from other civilizations.  Who had raw materials that were different and interesting.  As well as finished goods that were different and interesting.  And these civilizations traded with each other.

Civilizations established trade routes with each other.  Which connected civilizations with others in the unknown world.  Beyond the civilizations they knew.  Markets appeared on these trade routes.  Bringing the exotic from the furthest corners of the world to everyone.  As well as new ideas.  And innovation.  The civilized world grew more advanced.  More interdependent.  More peaceful.  And better.  There was more food.  More technology.  More goods and services.  And more leisure.  Giving rise to the arts.  And entertainment.

But it was not all good.  As cities grew they grew attractive to the uncivilized barbarians beyond the frontier.  Roving bands of hunters and gatherers.  Who were more partial to plunder than trade.  So a portion of their surpluses had to be set aside for city defenses.  The building of city walls.  Implements of wars.  And standing armies.  To defend their cities.  Their civilizations.  And their trade routes.  For as civilizations became more complex they became more dependent on trade.

Trade Improved the Quality of Life which is the Hallmark of an Advanced Civilization

Trade unleashed our human capital.  Because it drove innovation.  There was a big world out there.  Creating a lot of fascinating stuff.  And the only way to get it was to trade your fascinating stuff for it.  And when we did everyone won.  Life got better.  We learned new and interesting things.  That we used as building blocks for further innovation.  And further advancement.  Which led to a better quality of life.  The hallmark of an advanced civilization.

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Pottery Stored Food Surpluses and Created Advanced Civilizations

Posted by PITHOCRATES - October 26th, 2011

Technology 101

An Advanced Civilization requires a Food Surplus and Something to Store it In

Take a look around your kitchen.  Your pantry.  What do you see?  Storage jars.  Canisters.  And, of course, cups and plates.  They’re so prevalent in your life you don’t even notice them.  You just use them.  You drink from them.  Eat off of them.  Shake salt and pepper from them.  Store flour in them.  Sugar.  Coffee.  And tea.

It would be hard to live your life without the things in these containers.  It would be harder still if you had no containers to store these things in.

And it’s been this way since the dawn of civilization.  In fact, there would be no advanced civilization without one invention.  Pottery.  Because to form an advanced civilization requires a food surplus.  An excess of grain.  That they had to store.  Where animals and bugs could not get at it.  Or moisture.  Today we use storage jars and canisters in our pantry.  Back then they used pottery.  In their homes.  Even in their granaries.

Pottery allowed the Farmer and Artisan to Eat at the Harvest and Long After the Harvest

Pottery and agriculture were attached at the hip.  They both needed each other.  The mass farming of these early civilizations, before the plough simplified farming, required a lot of labor.  Which produced highly populated cities.  With a lot of mouths to fed.  And they did produce a lot of food.  So much that they had a food surplus.  To feed the farmers.  And the non-farmers.  The artisans.  At the harvest.  And long after the harvest.

They could grow a food surplus.  And did.  But a surplus without the ability to store it was useless.  So following the great agricultural developments came the all important granary.  And pottery storage vessels.

The development of pottery required a dedicated work force.  A division of labor.  The potters couldn’t farm.  They needed to spend all their time mass-producing pottery to meet the demands of their civilization.  Plates.  Bowls.  Cups.  And storage vessels.  To store that food surplus.  So both the farmer and artisan could eat.  At the harvest.  And long after the harvest.

The Division of Labor gave us Agriculture, Pottery and an Advanced Civilization

The hunter and gatherer life was simple.  You followed the food.  And hunted.  Which pretty much consumed all of your time.  And kept you on the move.  That changed after some key advances.  Agriculture.  And pottery.  To name only two.  The rise of these specialties allowed people to settle down.  To stop following food.  And, instead, to grow it.  And store it.

None of this would have been possible without the division of labor.  Which allowed the rise of artisans.  Specialists.  A middle class.  To make the things that made a civilization advanced.  And a food surplus.  Which allowed an advanced civilization to survive.

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The Division of Labor Produced the First Great Civilization: Sumer

Posted by PITHOCRATES - October 25th, 2011

History 101

The Sumerians’ Large-Scale Farming Produced the First Reliable Food Surpluses in History

The first civilization was in Mesopotamia.  The Cradle of Civilization.  In the Fertile Crescent.  That land between the Euphrates and Tigris.  Roughly modern day Iraq.  Where things started happening around 5,000 BC.  And lasted a long time.  A few thousand years.  And some.  During this time we see the first city-states.  Like Babylon in the north.  And Ur in the south.  Home of Abraham.  Yes, that Abraham.  The biblical one.  Who was part of the great Sumerian civilization.

Why here?  Because of the fertile soil along the river banks.  And the source of fresh water.  For drinking.  And farming.  For the Sumerians harnessed this water to irrigate their fields.  In Sumer they farmed for the first time on a grand scale.  Marshalling and organizing a great labor force.  Made possible by language.  That they could read and write.  They became specialists in food production.  And with these specialists we see the development of the division of labor.

They domesticated animals.  For food.  And for work.  This advance into large-scale farming produced the first reliable food surpluses in history.  Which allowed a lot of people to live in crowded cities.  Many of who had a lot of spare time.  And they used it.  To create other things.  Becoming specialists themselves.  Civilization became more complex.  And better.  Thanks to the division of labor.  That created all of these new specialists.

Sumer had the Surpluses to make Trade Possible and their Location put them in the Center of a Civilizing World

In Sumer they created the potter’s wheel.  Pottery.  And a kiln to bake it in.  Others did, too.  But they most likely did it first. Some thought about the potter’s wheel led to the wheel and axel.  Heavy transportation.  And the war chariot.  Pulled by their domesticated animals.  With the harnesses they made.

They also had boats.  For the two great rivers (Euphrates and the Tigris), their tributaries and the canals they made.  And, yes, they were builders.  Made easier by their creation of arithmetic, geometry, and algebra.  And they were astronomers.  Among the first to map the stars and planets.  Which formed the basis for much of the work the Greeks did.  Leading the way to open-water seafaring.  Navigation by the stars.  And long-distance trade.

A priest-king probably ruled each Sumerian city-state.  And each city-state worshipped in their own way.  As theocracies.  Everything belonged to the priest-king.  What the people produced went to the temple.  And the priest-king distributed the proceeds of their labors.  So there were no markets.  But there was trade.  For they have found items in Sumerian digs that are not native to Sumer (such as cedar from Lebanon).  But the details of that trade are sketchy.  But what is certain is that they had the surpluses to make trade possible.  And their location put them in the center of a civilizing world.

Fertile Soil, Irrigation, Large-Scale Farming and the Division of Labor Produced the Great Civilizations

Sumer was the first great civilization.  Egypt was right behind them.  With their kingdoms on the Nile.  Civilization soon followed on the banks of the Indus in Indian.  And on the banks of the Hwang-Ho in China.  These were isolated areas that began without outside influence from other advanced civilizations.  They were the first of the firsts.  And they all shared some things in common.  Fertile soil in their river valleys.  Irrigation.  Large-scale farming.  And a division of labor that produced the other great things of their civilizations.

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Division of Labor

Posted by PITHOCRATES - October 24th, 2011

Economics 101

The Division of Labor gives us our Houses, Food, Cars, Televisions, Smartphones, Laptops and the Internet

We can’t do everything ourselves.  It’s not efficient.  And most times not even possible.  We don’t build our own houses.  Grow our own food.  Build our own cars.  Manufacture our own high-definition televisions.  Smartphones.  Laptops.  And we don’t build our own Internet.  No.  Instead, people everywhere across the economy specialize in one thing (i.e., work for a living).  And together these specialists fit into the big economic picture.  Which gives us our houses, food, cars, televisions, smartphones, laptops and the Internet.

It started with the most basic division of labor.  Prehistoric women raised their young.  While prehistoric man hunted.  Which was necessary for the propagation of the species.  And us.  For if they all hunted and no one nursed the young the young would have died.  And with them the species of man.  For there was no formula back then.

The next great leap forward on the civilization timeline was the indispensible plough.  The prime mover of civilization.  With the food problem managed, famines were more the exception than the rule.  And with fewer people needed to produce a food surplus, people could do other things.  And they did.

The Division of Labor let us Create Surpluses in Food, Ploughs, Shoes, Tools, Harnesses, Etc.

The division of labor gave rise to artisans.  The first skilled trades.  Made possible by a food surplus.  As other people grew the food the artisans made the tools and crafts the farmers used.  They specialized in plough making and designed and built better and better ploughs.  Lots of them.  Shoemakers made shoes.  Lots of them.  Metal workers made tools.  Lots of them.  Leatherworkers made harnesses.  Lots of them.  See the pattern?

The food surplus gave us surpluses in ploughs, shoes, tools, harnesses, etc.  The division of labor let us create these surpluses.  Specialists made continual improvements in their areas of specialization.  Producing better things.  And more of them.  Which led to another key to the advanced civilization.  Trade.

The shoemaker didn’t have to grow food.  He could trade shoes for food.  Ditto for the plough maker.  The metal worker.  The leatherworker.  And the farmers didn’t have to make any of these things because they could trade food for them.  So we became traders.  We created the market.  And traders took their goods and/or services to these markets to trade for other goods and/or services.  First by foot.  Then by animal.  Then by boat.  Then by train.  Then by truck.  Then by airplane.  Artisans (i.e., workers) traded their specialization for the product and/or services of another’s specialization.  Then.  And now.

The Division of Labor made the Complex Simple and our Lives Rather Comfortable and Fun

The division of labor gave rise to the artisan.  The skilled trade worker.  The middle class.  People who can specialize in one thing.  And trade that one thing for the other things he or she wants.  Whether it be a skilled blacksmith hammering out farming tools.  A tool and die maker working in a factory.  An accountant.  Or a software engineer.  We have a skill.  Our human capital.  And we trade that skill to get the other things we’re not skilled in.  The end result is a modern, bustling, free market economy.  An advanced civilization.  And a high standard of living.

All thanks to the division of labor.  Which made the complex simple.  And our lives rather comfortable.  And fun.  Unlike prehistoric man.  Who knew of no such things as iPhones.  Indoor flush toilets.  Movie theaters.  Or restaurants.  No, he didn’t do much other than survive.  Which was no easy thing.  But he did.  And for that we are grateful.

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