Vt. businesses crunch health coverage numbers again (VT health exchange not ready for Jan 1)

Betsy Bishop and staff at the Vermont Chamber of Commerce spent much of the year on the phone, convincing business operators to bring their insurance business to the state's online marketplace. But now, they're calling back to let them know the plans they picked won't be available Jan. 1 because of bugs and delays.

"And we're having a bit of trouble convincing people to come off their decision. They're saying to us now we want to stay with Vermont Health Connect, which is great but there's no way for that payment mechanism to work," Bishop said.

Bishop says complete numbers aren't available. But of the 3,500 formerly enrolled in the Chamber's health plan, 650 will need to rework offerings after Monday's announcement. There may be more; 40 percent of the plan holders did not respond to Chamber mailings. Along with commercial businesses, at least 40 municipal entities must crunch the coverage numbers again.

"It was those communities that had really stuck with the process all the way to the unfortunately now bitter end," said Steve Jeffrey of the Vt. League of Cities and Towns.

Jeffrey says some will pay more, others less by continuing their existing coverage. That's true for both the employer and the employee. He suggests reopening direct enrollment through carriers for Jan. 1 coverage, which closed last week prior to the announcement.

Chamber spokespeople want more-- the ability to keep current plans through the end of 2014. That would grant insurers, employers, employees, administrators, unions, and municipal entities time to sort out the rules without deadlines constantly looming.

The businesses affected by this are generally those that put substantial amounts of time and energy into making the Health Connect site work-- multiple hours a week as opposed to the hour a year Chamber officials say is typical.

I spoke with a municipal administrator Wednesday who told me she spent an hour waiting on hold to withdraw the town's application, allowing them to enroll in the desired plan through a carrier.

Business operators that chose to offer through Health Connect will have current plans extended for three months if they do nothing.

>>>So, what I want to know is if the doctors are going to flee the state in mass when single-payer kicks in?

And go where?

A licensed physician, alas, cannot simply move from Vermont and set up a new practice in, e.g., Texas, without retaking various licensing exams and fulfilling burdensome requirements. The purpose of these licensing restrictions was to limit the number of physicians that could legally practice in any particular state, thus keeping their rates higher than a true free market would have resulted in.

I feel sorry for the doctors, but the truth is that ever since the old Flexner Report, they have been a kind of protected guild. Naturally, all such protections are made with the excuse that “It’s for the good of the public,” but the truth is that it was done mainly for prestige/economic reasons.

I think what will happen in Vermont is what I see happening in general: the older physicians will retire a little sooner than they expected to; they will be very reluctant to recommend medicine as a good career to bright young high school and college students; and some of the younger doctors already in practice will branch out into other kinds of care that are not yet so highly regulated. For example, many dermatologists no longer rely only on their practice for an income, but carry their own unique line of skin products — their offices and waiting rooms look like the beauty and skin-care section of a major department store. Some physicians — internal medicine, mainly — give an afternoon or two per week at some of the health food stores, answering questions about food supplements, vitamins, etc. They usually run their own clinics where they practice “integrative medicine” or “complementary medicine” combining orthodox medical therapies with alternative practices. Nothing wrong, per se, with this, of course, but for me, it’s always interesting to see how people respond in whatever pockets of freedom remain during times of political restrictions on liberty.

>>>Physicians relocate to different states all the time.

No they don’t. If they could do so “all the time,” they would. Since they don’t, it’s because there are artificial state-created hoops through which they must jump. That takes time and energy: two resources that are always scarce.

>>>In most states, obtaining a license is primarily a function of the state performing an investigation to assure proper degrees, credentials, and past performance.

LOL! Right. That’s what I posted before. And although the sales pitch for such state investigation is that it’s to “protect the public interest,” the actual economic OUTCOME is to restrict the number of physicians able to respond to the demand for medical care in a given location. This is combined with restrictions on the number of medical schools that can be created (and, of course, WHO can create them) and therefore, a restriction on the number of people admitted to medical school. The sales pitch: “IT’S TO PROTECT THE PUBLIC AND KEEP THE QUALITY OF MEDICAL CARE HIGH!!” The actual economic effect: FEWER DOCTORS.

Try doing a little homework, catnip hombre:

http://mises.org/journals/jls/3_1/3_1_5.pdf

As for current state licensing burdens on new physicians, or those already in practice who want to move or practice in another state, the AMA site says this:

“Even for physicians with uncomplicated histories who submit complete and accurate applications, delays in obtaining a medical license may be encountered. Physicians should plan for at least a 60-day period from the time they submit a completed application for license and the actual date licensure is granted. Physicians who are graduates of a medical school outside the United States should anticipate a slightly longer period. All physicians should be cognizant of the fact that, in general, the highest volume of licensure applications is received between the months of April and September. This is the peak period because physicians with families want to relocate before the academic school year starts for their children, residents want and need licensure to begin practicing, and state employees with school-age children often take their earned vacation time during this period. Finally, it is important to remember that hospital credentialing and qualification for medical malpractice insurance are based on possession of full and unrestricted licensure. This too may mean additional time before a physician can actually begin practicing.

Physicians informed about the process and working cooperatively with the licensing board need not find licensing an unpleasant experience. Members of the medical profession should always remember that the business of medical licensing boards is to protect the public from unqualified and unfit physicians. However, licensing boards also strive to ensure a process that protects the legal rights and privileges of physicians. While maintaining this balance often appears bureaucratic and cumbersome, the end result is improved health care for the people of the United States.”

http://www.ama-assn.org/ama/pub/education-careers/becoming-physician/medical-licensure.page

I don’t know what an “uncomplicated history” is, but I’ll bet most physicians have **some** complication somewhere in their past that needs “investigation.” Most people do, don’t you think so? I do. And 60 days? Let’s see. At 5 days per week, that’s at least 12 weeks, or 3 months just to be investigated. The AMA admits that it might even take longer. 4 months? 6 months? I don’t know. The AMA doesn’t know. And guess what, catniphomme . . . neither does the applying physician. In your opinion, does a state of not-knowing how long an investigation might take encourage lots of relocating? Or would it tend to discourage it?

I think it discourages it — most economists who favor voluntary market-based solutions to problems think so, too — and furthermore, I believe that discouragement is ultimately the real **purpose** of the investigations. Once more, just so you get it:

The sales pitch? “We investigate for the purpose of maintaining high standards of medical care. It’s for the innocent public’s own good.”

The actual economic outcome? Fewer doctors move around, so the supply of medical care can never easily satisfy the demand for it. And the result of that is, of course, higher incomes for medical practitioners.

Nice try, but no lollipop for you, catnip.

Oh, and while you’re wondering what’s just happened to you, watch this excellent video of Milton Friedman speaking to doctors at the Mayo Clinic, around 1978. The lecture is mainly on the danger of socialized medicine, but he touches on the issue of state licensure:

http://www.youtube.com/watch?v=MJgbc8ojYUg&list=PL5E904E0D6DCAAA62

This particular upload appears to be divided into 6 parts. Pay particular attention to the Q&A toward the end.

You’re welcome.

Enjoy!

>>>Doctors, in general, are far smarter, in general, than are lawyers.

Yes, I hear that often . . . but only from doctors. I never hear it from lawyers. I’ve also seen no data to support that statement from neutral third parties (like psychologists) who could test the two groups and compare the results. Personally, I’ve met plenty of very stupid doctors.

>>>Some of them are young, more naive and inexperienced and in debt…they can’t pick up and move as easily as those with grey hair, lots of experience in dealing with the licensing boards and regulators.

Sorry, I don’t understand the relation between not having grey hair and not being able to relocate easily. School debt will follow them irrespective of where live. There’s no way out of school debt — no bankruptcy procedure — except to pay it back or literally leave the country. There is no licensure requirement or state investigation or federal investigation of someone’s debt status if he moves from Vermont to Texas. He simply moves and lets “Aspire” or some other debt-consolidation agency know where he is. It takes precisely ZERO time.

>>>So, though you smirk more in sorrow rather than in anger, doctors are far better prepared for this than are patients. And those waxing smug after a lifetime of envying and resenting doctors.

The reason I wax smug is not because I envy doctors, nor because I resent them. For many decades there has been a hand-in-glove relationship between the medical profession and government (both state and federal). The late Thomas Szasz, MD (author of “The Myth of Mental Illness” which promptly got him blacklisted from the A.P.A.) wrote that the state legitimizes doctors via licensing (i.e., “You, with your specific kind of allopathic training, are legit; you are a ‘real’ doctor. Everyone else without that kind of training is either NOT a ‘real’ doctor or simply a quack), and in return, the medical profession reports to state authorities who was born, who died, and who has various kinds of STDs (HIV, for example). Under Obamacare, the state (via the IRS) will know who drinks, who smokes, etc., etc.

I am smug because — sorry — this is what happens when you make a deal with the devil. Getting special favors from government in order to protect your market (er, uh, for the public’s own good, of course!) is always a devil’s bargain, and will inevitably bite you in the rear end. It’s now biting doctors in their collective gluteus maximi. I feel sorry for them . . . and, without question, I feel even more sorry for patients. Ultimately, it will be the consumers of medical care who will suffer the most.

>>>Guild, my foot. It takes a multimillion dollar infrastructure to educate any kind of health pro…doc, dentist or nurse.

Yes, I hear that often. But only from the providers of multimillion dollar infrastructures (”You need us! Can’t you see that?”). The historical facts are that the AMA fought to have states license only “approved” medical schools in order to squelch competition from two groups of care providers that were extremely popular with Americans in the mid-19th century: homeopaths and eclectics. Instead of competing freely with them in a spirit of “May the best kind of care win,” they sought to eliminate competition by means of state force. That’s the history, and those are the facts. See this PDF:

http://mises.org/journals/jls/3_1/3_1_5.pdf
“The Early Development of State Licensing Laws in the United States, 1875-1900”

Also watch Milton Friedman’s talk to doctors at the Mayo Clinic in 1978 on the trend toward greater government regulation and socialized medicine in the US:

http://www.youtube.com/watch?v=MJgbc8ojYUg&list=PL5E904E0D6DCAAA62
(in 6 parts)

Friedman picks up where the PDF linked above leaves off, as he mentions the famous report by Abraham Flexner in 1910, the upshot of which was to close down many medical schools in the US, thus limiting how many bright students — all whom might have done very well on their organic chem exams — could become doctors.

See this link for a brief description of the Flexner Report:

http://en.wikipedia.org/wiki/Flexner_Report

re: Yes, I hear that often . . . but only from doctors. I never hear it from lawyers. I’ve also seen no data to support that statement from neutral third parties (like psychologists) who could test the two groups and compare the results. Personally, I’ve met plenty of very stupid doctors.

Oh, certainly.

However, how many lawyers do you know who were doctors *first*--?

I know *Many* doctors who went on, almost as a lark, to go to law school because it was more like Book Club compared to the demands and intensity of their medical educations. They wanted to enhance their medical degrees with a layer of knowledge to protect them from lawyers.

I have never met a single lawyer who went on to medical school, and it would certainly enhance the ambitions of a medical malpractice specialist.

For that matter, few lawyers become anything else. They don't become engineers, nurses or other technicians. Now, many nurses go to law school and end up suing doctors. But lawyers just stay what they are, unless they write legal thrillers.

This is because law school is the default next step for many non-useful BA degrees, and the useless grads have nowhere else to go. Law school has no prerequisites like organic chemistry or calculus. You can get a degree in bed wetting and some law school, somewhere (Texas seems to have one on every city block) will turn you into a lawyer.

That the infrastructure is multimillion dollar is inescapable, unless you deny the evidence of your own eyes when you look at the Mayo, Scott and White (billions)--etc. All you need to extrude one more lawyer is a classroom and some broken-down rainmaker who fancies himself a pedagogue. Cheap. That's why there's a law school at so many second-rate universities.

It is tiresome to point out that the AMA represents less than 17% of physicians, and most of those they represent are non-clincians, but want to be administrators and bureaucrats and stay far away from patients.

Th AMA is little more than the holder of patents for medical documentation that they've promoted to the Obama admin in exchange for selling out doctors' interests. Sort of like your average GOP senator, like Rubio, delivering the conservative voters while quietly supporting amnesty.

The AMA also has little to do with licensing--that is left to the states who want the doctors they educate to stay in state--unless those states are run by morons like in Vermont. Most doctors in Vermont, I believe, are not educated in Vermont and probably come for the rural scenery. They draw off of Massachusetts medical schools.

Gee…was Milton Friedman in the private sector? Really?

Um, those with grey hair are likely to have paid off their debts. I thought that would be common sensical.

The younger the doc, the more likely they are still in debt. Also young med grads have a bad habit of overspending their first years out of residency, having bought into a cliché of having lots of money when they are merely upper middle class, at least with primary care physicians. Two public school teachers make about as much as a primary care physician. It costs close to nothing to educate another pernicious educator.

Now, if you want to be an interventionist cardiologist (who puts in stents)--you face about ten years of post medical school education, and you can charge plenty! And those who have those stents put in--well, a lot of them are lawyers, so maybe it wasn't worth it…but they'll take that stent anyway.

I was amused recently by listening to a confirmed, smug, doctor-hater try to deal with having his ticker and his life, and his quality of life, saved by an interventionist cardiologist. And the bill for the doctor's skill and effort was tiny, just about what that doctor-hater earned in a week. The bill for having the use of that multi-million dollar hospital for a few hours, however, was much more. The doctor-hater was in a real quandary, since he wouldn't be around to hate doctors without a doctor. He managed well, however, to be both ungrateful and ungracious and dismissive and a Democrat.

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