This Too? This Too.

My wife has been having some health struggles lately. Serious struggles.

This is on top of a life that’s above average on the crazy difficult scale of late.  Work has been harder than it’s ever been, and I’m not wearing the stress very well (at least until my recent vacation).  And even when I was in school, I was able to make it through because Theresa kept things running at home when I wasn’t able to find the attention span.

And when life is at a pace where I’m tempted to give up and say “I can’t take it anymore” God has added this to the pile too.  When I’m saying “no more” God says “actually, this too.”

1Thessalonians 5:18:

give thanks in all circumstances; for this is the will of God in Christ Jesus for you.

If you look up the word “all” in your concordance the Greek word there mean (wait for it) “all.”  Give thanks in ALL circumstances for this is God’s will for your life.  This one too?  Yup.  Give thanks for everything.

But that doesn’t mean it’s not hard or that you can handle it.  There’s another all to remember in 1Peter 5:

casting all your anxieties on him, because he cares for you.

Cast all your cares on Him.  There’s not a single one you should try to carry on your own.

If you’re anything like me you forget that.  Pretty much every day.  I try to handle it on my own.  And God’s the One who handles it.  And you’re thinking, again if you’re like me, do I cast this anxiety or care onto Jesus too?  And what does He answer?  Yes…this too.

His burden is light, and yours is hard.  And He wants to trade.

And this is why you can give thanks in all things:  because every hard thing He sends your way is a reminder that He’s got this and that He wants to take it off your back.  So let Him.  Walk in His grace, giving thanks for the hardest of the hard, and He’s got this.  This too.


Medicine, Economics and the Future

Economics matters.  And so do incentives.  When young people are thoughtful in choosing a course of study before or during college, they’ll consider some of the following:

  • What will I be good at?
  • What could I enjoy doing?
  • What careers will be easy to find jobs in?
  • What fields of study will lead to a career that pays well?j

Now consider this:

The United States faces a shortage of as many as 90,000 physicians by 2025, including a critical need for specialists to treat an aging population that will increasingly live with chronic disease, the association that represents medical schools and teaching hospitals reported Tuesday.

via U.S. faces 90,000 doctor shortage by 2025, medical school association warns – The Washington Post.

So what’s driving the expected shortage?  It’s obviously not young people deciding that medicine is a bad choice for finding work.  Health care demand will continue to rise for some time.  And as for people being good at it or enjoying it, I have a hard time imagining that the current generation of college students is any less intelligent than previous ones nor does seem likely to have a smaller subset who are attracted to careers serving and helping others.

So what’s left?  Two possibilities:  either 1) there are just fewer people seeking higher degrees or 2) those seeking higher degrees are concerned medicine won’t pay well enough to be worth the investment.

The first one is undeniably true.  We are facing a demographic winter, and the baby boomers and generation X did not have enough children to support the needs of our current societal expectations as the boomers retire.

But what of the second possibility?  How could it be true?  If there is a shortage of physicians coming, and the demand for health care is almost certainly increasing, how will those careers not be increasing in income potential?  If the laws of supply and demand work, less supply (fewer doctors) and more demand should increase the potential earning for a doctor very quickly.  And that should lead to it being a more attractive choice and over time the shortage would be a non-issue.

But sadly, supply and demand will not drive up the potential income in health care.  That’s because there are price controls set by the number one purchaser of health care goods:  Medicare.  Since doctors cannot negotiate prices with Medicare (either they take Medicare patients for the stated price or they don’t take Medicare patients at all) it makes the earning potential shrink drastically.  Medicare and Medicaid (also price controlled) account for almost half of all health care spending.  This gives the government the ability to keep prices controlled, which in turn makes the medical profession less attractive, especially considering it takes longer to finish the schooling.

If health care is truly to be a working industry long term, and we want young men and women to think practicing medicine for 30-40 years is an attractive profession, we have to allow the free market to work there.  And that’s precisely what we have continued to avoid doing with almost every reform for the last 60+ years.

Engaged patients + free markets in health care will bring an efficient, affordable, high quality industry to us, and that’s better for everyone old and young alike.


Memories Can Fool You

What is below is a snippet from a “political” article about the Affordable Care Act and the recent DC Circuit decision.  Most of the article, though, is about better discourse and the way memories work, and I think it’s worth your time to read, no matter what your opinion is about the new health care law.  Enjoy!

This is particularly true when there is an answer people very much want to get to. It’s called hindsight bias: Once we know the “correct” answer, we tend to believe that we would have figured that out even without being told. In fact, if we’re asked to predict the answer in advance, we will often edit our memories of what we did believe, to show that “we knew it all along.” This is not a conscious attempt to deceive someone else; it is part of the mind’s unconscious mechanisms for deceiving itself. Elizabeth Loftus theorizes that this has self-protective functions, helping to tamp down distressing memories and boosting our self-esteem. But of course this mechanism probably gets a powerful boost when you add in the sort of motivated cognition that we see around political topics.

via What We’ve Forgotten About Obamacare – Bloomberg View.

File Under Unannounced Consequences (Health Care Related)

As of April 1st (no fool’s joke here) the Affordable Care Act exchanges are closed to most takers:

As AP reporter Connie Cass explains:

With limited exceptions, insurers are refusing to sell to individuals after the enrollment period for and the state marketplaces. They will lock out the young and healthy as well as the sick or injured. Those who want to switch plans also are affected. The next wide-open chance to enroll comes in November for coverage in 2015.

The exceptions are generally limited to “qualifying life events” — marriage, loss of a job, etc.

Here is something you may find even more surprising: most of the uninsured don’t even know the market is closed –

A survey by the Kaiser Family Foundation in mid-March found that 6 out of 10 people without insurance weren’t aware of the marketplace deadline on March 31.

via You Can’t Buy Insurance until Next November | John Goodman’s Health Policy Blog |

It used to be that we had 50,000,000 uninsured that we needed to do everything we can to help as soon as we can.  When presented with the opportunity to buy insurance through the exchange, some at generous subsidies, with zero extra cost for health history or pre-existing conditions, most of the uninsured failed to do so.

And now they can’t do anything about it, no matter their financial position, until November.

How does this make things better again?

Travelling, Speaking and a Little Bill Cosby for Good Measure

So I know I’ve been posting very sporadically and not on schedule this week, but I warned you this would happen. Marketing feels less ominous right now, but it’s still kicking my tail around the ring.

One reason it’s a bit harder than it really needed to be is that work is crazy and I have two trips. Last week I had to be in Memphis and Houston in a two day window and this week I’m attending and speaking at a conference in Denver (wrote this post on my iPad on the plane, in fact, which is how I found time).

I’m speaking on a topic that is one of my favorites: health care economics from a biblical perspective. One of the joys of the job that I got thrust into for Samaritan when we had to do all the lobbying from 2006-2011 (at which point I started passing more of it on to others) is that I got to interact with some really smart people who come at health care from varying perspectives. The perspective I gravitate towards is the economic one, given my level of interest in econ.

Public speaking is one of my favorite things to do. I recently wrapped up a class for some of my co-workers on the topic, and I plan to do another one when school is finished, so something starting in February of next year I’d guess. This year I avoided most of my travel but I was willing to do some travel if I was asked to speak. And in the next few weeks I’m speaking at two conferences, this one and another in Dallas next Month.

There’s something about the spoken word that excites me. When I was a kid I used to fall asleep listening to cassette tape copies of Bill Cosby records that my dad had lying around. Cosby is, in my opinion, one of the finest comedians of all time. He has changed a bit of late (probably since his son was murdered if you’re looking for a time frame) but his ability to turn the everyday life of a dad or child into a story that causes gut wrenching laughter is almost unparalleled. If I were to name a newer comedian who has a similar style and skill I’d pick Jim Gaffigan or Brian Regan, but I’d bet dollars to donuts that Cosby influenced both of them.

And Cosby influenced me as well. It was from Cosby and listening to his routines over and over again that I learned how to have cadence in my speaking. Even when you’re not trying to make people laugh, you have to keep their attention. And Cosby knew how to pause, to use non-verbals, body language, strange sounds and the like to keep the attention of almost anyone with a heartbeat. And in an era where so many comedians were turning to the “easy laugh” of profanity Cosby was able to take a story about feeding the children breakfast or going to the dentist into a memorable, repeatable, hilarious experience for the listener.

I may write more on Cosby later, because his entire life is a fantastic story, only some of which comes out in his comedic acts. He was the first african american in several pursuits, and even at the age he is today can make even young folks laugh.

I don’t know that there will be any laughter tomorrow at my lecture. If there’s an opening I’ll take it, and if it falls flat I’ll say something self-deprecating and move on. But when I talk I’ll be thinking about how to communicate my topic with beauty, grace, humility and humor, and to keep the attention of anyone who shows up to hear.

Hurry Up And Wait (for the Doctor)

One of the pushes of health care reform ideas for the last decade or more has been to get everyone “covered.”  The key provisions in the Affordable Care Act are aimed at getting more Americans covered under health insurance.  We got to the point where health care and health insurance coverage were used interchangeably as if there were no way to get any care without having insurance.

Assuming for a moment that the law succeeds in getting more people insured, it may not accomplish the spoken goal of getting more care for more people, even if they have insurance:

A survey of physician practices in 15 metropolitan areas across the country, which was taken before the health law expanded coverage, found that the average wait time for a new patient to see a physician in five medical specialties was 18.5 days.  The longest waits were in Boston, where patients wait an average of 72 days to see a dermatologist and 66 days to see a family doctor. The shortest were in Dallas, where the average wait time is 10.2 days for all specialties, and just five  days to see a family doctor.

The bad news is that fewer doctors are accepting Medicaid: An average of 45.7 percent of physicians surveyed take Medicaid coverage, down from 55.4 percent in 2009. Acceptance rates varied widely, however, ranging from 73 percent in Boston to 23 percent in Dallas. An average of 76 percent of physicians surveyed accept Medicare.

via In cities, the average doctor wait-time is 18.5 days.

Note two things here.  First, note that fewer than half of all physicians accept Medicaid.  Most of the newly insured in the first few months of PPACA are insured under Medicaid, and there will be few doctors taking the patients even now that they’re “covered.”  Second, note the wait times in the first paragraph.  The longest by far are in Boston, where they have had a state-run version of PPACA since 2007, in a state with one of the highest insured rates in the USA.  Note also that the city with the lowest wait time to see the doctor is the same city with the lowest acceptance rates for Medicaid.  The better doctors are compensated (Medicaid is a low payer) the more doctors there are to see patients.

Getting more people covered may actually reduce access to care, especially for the poorest among us.  When trying to solve a problem, always watch out for unintended consequences, and consider how incentives move the systems you’re affecting with the “solution.”

Watch for More Overcrowding at the Emergency Room

One of the topics I occasionally get asked to speak to groups about is health care policy.  I’ve followed national and state health care policy, mostly from an economics angle, for the past 7 years pretty consistently.

One of the points used to sell the Affordable Care Act was that health care costs are high because of over-utilization of the emergency room for care.  In particular, the allegation was that is was the primary place the uninsured get their care.  So, the argument went, everyone having insurance would mean that the emergency rooms would be less crowded.

A simple study of E/R use, particularly in posts-health-reform Massachusetts, would have shown that this isn’t the problem.  In fact, the only segment of the society that used the E/R at a higher per-person rate than others is the Medicaid population.  And this is not because the Medicaid patient has a predisposition to emergencies or towards using the emergency room…it’s because so many states pay so little for Medicaid reimbursements that many doctors have stopped taking new Medicaid patients, which leads to the E/R being their only access point.

A new study has come out confirming what many of us knew going into the PPACA’s passage, that increasing the Medicaid roles increases Emergency Room use.  And now the arguments regarding the law’s intentions are changing:

“I would view it as part of a broader set of evidence that covering people with health insurance doesn’t save money,” says Jonathan Gruber, a health economist at the Massachusetts Institute of Technology, who has also studied Oregon’s Medicaid expansion but is not affiliated with this study. “That was sometimes a misleading motivator for the Affordable Care Act. The law isn’t designed to save money. It’s designed to improve health, and that’s going to cost money.” (emphasis mine)

via Study: Expanding Medicaid doesn’t reduce ER trips. It increases them..

The law isn’t accomplishing any of its stated goals.  The stated goals were laudable.  But the law’s economic drivers will accomplish worse, less affordable care and I am convinced that come this time next year there will be more Americans uninsured than there are now.  Time will tell.