GOOD NEWS MORE RESIDENCY SPOTS COMING

[laricb]

http://www.usatoday.com/story/news/...poses-record-funding-for-new-doctors/5836317/

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[Dharma]

I don't see anything particular about increased residency slots besides a quick mention. That has to go through Congress and I don't think we will be seeing any massive increase anytime soon. There are plenty of primary care residency slots in East-Bumblef*(k that routinely go unfilled, a lot of which are AOA and now (or soon to be) accessible to all. (Any coincidence in the timing of these events?) I bet those are the first to be filled, because they are just waiting and do not need pass through the dysfunctional sieves that exist in Washington. I know that's a lot of speculation, but it kinda makes sense.

I'd be careful wishing for more residency slots in general though. Saturation could lead us down a road similar to law school grads. Many markets are already saturated. The key is getting people to go become docs in East-Bumblef*(k, which this budget proposal could do. Sign the kids up before they know what they're getting into and force them into residency/post-residency work wherever Uncle Sam sees fit.

 

[AlbinoHawk DO]

I don't see anything particular about increased residency slots besides a quick mention. That has to go through Congress and I don't think we will be seeing any massive increase anytime soon. There are plenty of primary care residency slots in East-Bumblef*(k that routinely go unfilled, a lot of which are AOA and now (or soon to be) accessible to all. (Any coincidence in the timing of these events?) I bet those are the first to be filled, because they are just waiting and do not need pass through the dysfunctional sieves that exist in Washington. I know that's a lot of speculation, but it kinda makes sense.

I'd be careful wishing for more residency slots in general though. Saturation could lead us down a road similar to law school grads. Many markets are already saturated. The key is getting people to go become docs in East-Bumblef*(k, which this budget proposal could do. Sign the kids up before they know what they're getting into and force them into residency/post-residency work wherever Uncle Sam sees fit.

Yet if we don't increase primary care doctors we'll see the nurse lobby having more muscle against Washington. I recommend opening more primary care slots.

 

[Dharma]

it's not so much about numbers as is the placement of those numbers. there will be PLENTY of available primary care residencies (they are there already unfilled) especially after this merger goes through. they will be in the middle of nowhere, but that's where the shortage is, and that's where they will go. my bet it that every last primary care residency will be required to be filled before anything new opens. the big markets have plenty of docs to go around and it's easy to attract into these areas (hence the saturation).

 

[laricb]

I don't see anything particular about increased residency slots besides a quick mention. That has to go through Congress and I don't think we will be seeing any massive increase anytime soon. There are plenty of primary care residency slots in East-Bumblef*(k that routinely go unfilled, a lot of which are AOA and now (or soon to be) accessible to all. (Any coincidence in the timing of these events?) I bet those are the first to be filled, because they are just waiting and do not need pass through the dysfunctional sieves that exist in Washington. I know that's a lot of speculation, but it kinda makes sense.

I'd be careful wishing for more residency slots in general though. Saturation could lead us down a road similar to law school grads. Many markets are already saturated. The key is getting people to go become docs in East-Bumblef*(k, which this budget proposal could do. Sign the kids up before they know what they're getting into and force them into residency/post-residency work wherever Uncle Sam sees fit.

This is the first time a president is pushing for the increase

 

[Mehd School]

I wonder if Mr. Obama is planning on pulling the rug out from underneath the NHSC Scholarship while he's at it.

 

[Dharma]

This is the first time a president is pushing for the increase

One word: Congress.

 

[Dr. Zombie]

Primary Care slots would be better filled attracting more students, if the compensation was increased, but no one wants to be 300k debt and making low money after all those years sacrificed.

 

[wjs010]

congress will not let it happen.

 

[user3]

This is the first time a president is pushing for the increase

I think reimbursements and working condition-related issues should be addressed first rather than the number of residents being trained...

 

[NurWollen]

I don't see anything particular about increased residency slots besides a quick mention. That has to go through Congress and I don't think we will be seeing any massive increase anytime soon. There are plenty of primary care residency slots in East-Bumblef*(k that routinely go unfilled, a lot of which are AOA and now (or soon to be) accessible to all. (Any coincidence in the timing of these events?) I bet those are the first to be filled, because they are just waiting and do not need pass through the dysfunctional sieves that exist in Washington. I know that's a lot of speculation, but it kinda makes sense.

I'd be careful wishing for more residency slots in general though. Saturation could lead us down a road similar to law school grads. Many markets are already saturated. The key is getting people to go become docs in East-Bumblef*(k, which this budget proposal could do. Sign the kids up before they know what they're getting into and force them into residency/post-residency work wherever Uncle Sam sees fit.

I dunno, do they pay well in East Bumblef*(k?

 

[felix2929]

Do we really want them to increase residency spots? Doesn't anyone else worry about going the way of law school grads?

 

[GUH]

I dunno, do they pay well in East Bumblef*(k?

I've heard that rural primary care pays more than urban primary care, especially when cost of living is taken into account.

 

[NurWollen]

Do we really want them to increase residency spots? Doesn't anyone else worry about going the way of law school grads?

I say, expand residency spots until 2017 ) and then stop expansion down to zero after that

I've heard that rural primary care pays more than urban primary care, especially when cost of living is taken into account.

Yeah, I've heard the same thing, and I also have heard that rural primary care gets more variety as far as what they can do, i.e. ED and hospitalist moonlighting, simple surgeries, scopes, etc. Sounds more fun to be honest. As I have a wife and kids that will come with me anywhere, I'm not as drawn to nightlife and other big-city offerings.

 

[ChrisGriffen]

can we stop with the law school comparison? every thread somebody posts about how hard it is for lawyers to get jobs. there is a SHORTAGE of doctors, and the shortage is predicted to get worse. we are a loong way from market saturation

 

[user3]

can we stop with the law school comparison? every thread somebody posts about how hard it is for lawyers to get jobs. there is a SHORTAGE of doctors, and the shortage is predicted to get worse. we are a loong way from market saturation

But aren't several specialties pretty saturated already?

 

[DocEspana]

Yet if we don't increase primary care doctors we'll see the nurse lobby having more muscle against Washington. I recommend opening more primary care slots.

We are already many fold stronger than the nurse lobby. In number of lobbyists, total money spent and money per lobbyist. What we are not is unified. Medical lobbying is the most disorganized lobby you'll ever see.

The AMA represents every field and every physician, whether they want it or not. And is very deeply entrenched in every aspect of both political medicine and actual medical practice. It literally serves a dual role as lobbyist and as the federal government's personal contractor for medical issues.

The primary care doctors generally don't trust the AMA and say so vocally enough to undercut it at every turn. This stems back to the AMA creating the payment structure that rewards specialists more than primary care for the same procedures. They refuse to aid the AMA because of bad blood over that.

Every single specialty group has their own lobby which will undercut the AMA whenever possible as the AMA had been trying to make amends to primary care for 7ish years now and it's coming at the expense of specialist's demands. So they go out now and lobby themselves, often on spite of the AMA.

Then there are the two "other" physician collective groups. One is nearly pure socialist and the other is basically the republican party line signed by MDs and DOs.

And the nurses? One singular voice. Zero dissent. No controversy. Cannot be divided and conquered.

 

[touchpause13]

Ugh. That's frustrating DocE. Having a unified front and a unified message could probably kick this nurse doctor bullcrap to the curb...

But who knows. Personally I think it would be more important to try and increase reimbursement for primary care before opening up more residency slots that are going to go unfilled anyways

 

[Dharma]

can we stop with the law school comparison? every thread somebody posts about how hard it is for lawyers to get jobs. there is a SHORTAGE of doctors, and the shortage is predicted to get worse. we are a loong way from market saturation

I think it's ok to bring up; better than ignoring the possibility. There is a shortage of physicians in certain areas. The issue is one of distribution. Simply pumping up numbers will not solve that problem and could have negative unintended consequences.

 

[Dharma]

I dunno, do they pay well in East Bumblef*(k?

Definitely more than in the city. Sometimes a lot more coupled with more job satisfaction.

 

[EMDO2018]

can we stop with the law school comparison? every thread somebody posts about how hard it is for lawyers to get jobs. there is a SHORTAGE of doctors, and the shortage is predicted to get worse. we are a loong way from market saturation

There was also a shortage of lawyers and pharmacist not too long ago.

 

[ChrisGriffen]

What specialty has market saturation?
...and when exactly was there a pharmacist or lawyer shortage in america?

 

[Postictal Raiden]

IMO, there's some level of saturation nearly in every field, from pharmacy to law to even medicine. Baby bommers make up a good chunk of the working class, especially in professions that require long years of education. Last time I looked at the data, the median age of practicing physicians in the US has risen from mid forties to mid fifties over the past few decades. Same thing is happening in pharmacy. Despite the increasing number of first year enrollment at medical and pharmacy schools, the projected retirement over the next 15 years or so will provide adequate employment opportunities.

 

[Otto of the Silver-Hand]

What specialty has market saturation?

Pathology

 

[TheWeeIceMan]

What specialty has market saturation?
...and when exactly was there a pharmacist or lawyer shortage in america?

Path and Rads are probably the big two that are considered to have tight markets. I think Cards is getting there too.

From what I've read, pharmacy was pretty wide open in the late 90s/early 2000s. Sign on bonuses and multiple offers for grads. Fast forward 10+ years and it seems to be a totally different story. Too many schools are opening and pumping out grads way to fast for the market to absorb.

As for law, I have no idea if there was a recent shortage. Maybe you could say there was a shortage if you compare previous markets to how crappy today's law market is.

 

[GUH]

If the free market were allowed to determine physician reimbursement (rather than Medicare/Medicaid), any physician shortages would self-correct within a few years, since individuals and insurance companies would compete for these services and as pay increased, more new docs would choose to enter these fields.

As it is, however, the government essentially determines physician pay by setting reimbursement rates and exacerbates physician shortages by perpetuating the current residency paradigm.

 

[Otto of the Silver-Hand]

As for law, I have no idea if there was a recent shortage. Maybe you could say there was a shortage if you compare previous markets to how crappy today's law market is.

Attorneys were being churned out during the stock market boom of the late eighties to early nineties when lawyers were needed to negotiate LBOs , mergers and acquisitions... continued to boom during the tech bubble in the mid nineties... probably reached steady state at the start of housing bubble..... became saturated when the housing bubble burst and the stock market crashed.

 

[NurWollen]

If the free market were allowed to determine physician reimbursement (rather than Medicare/Medicaid), any physician shortages would self-correct within a few years, since individuals and insurance companies would compete for these services and as pay increased, more new docs would choose to enter these fields.

As it is, however, the government essentially determines physician pay by setting reimbursement rates and exacerbates physician shortages by perpetuating the current residency paradigm.

I like the way you think.

 

[Dharma]

If the free market were allowed to determine physician reimbursement (rather than Medicare/Medicaid), any physician shortages would self-correct within a few years, since individuals and insurance companies would compete for these services and as pay increased, more new docs would choose to enter these fields.

As it is, however, the government essentially determines physician pay by setting reimbursement rates and exacerbates physician shortages by perpetuating the current residency paradigm.

Amen to that! It's been a looooooong time since a truly free market was allowed to flourish in this country. Not sure if we'll ever see it again though. A touch of Laissez-faire would do us good. Limited regulation of some sort is necessary, since every game needs its rules and referees. But the good refs go unnoticed and don't determine the outcome of the game.

 

[MalachiConstant]

If the free market were allowed to determine physician reimbursement (rather than Medicare/Medicaid), any physician shortages would self-correct within a few years, since individuals and insurance companies would compete for these services and as pay increased, more new docs would choose to enter these fields.

As it is, however, the government essentially determines physician pay by setting reimbursement rates and exacerbates physician shortages by perpetuating the current residency paradigm.

I don't really see how this would work. As has been well established, the "physician shortage" problem is one of distribution, both geographically and by specialty. Many places that are under served are rural and economically depressed with disproportionate shares of medicare/medicaid patients. You can't increase those reimbursements without pumping more money in, which I doubt anyone proposing a free market approach would support. If there aren't enough people willing and able to pay for a service, then how could reimbursement rise. The only incentive I see for insurance companies to pay more for the primary care services that are needed, is by perhaps attracting more clients. In many areas where there is a shortage, even if this were to occur, I don't see it making enough difference financially, given the overall patient base, to entice a sufficient number of physicians to locate there.

Don't get me wrong, I'm all for increasing physician reimbursement, and I think the efforts at cutting healthcare expenditures by focusing on physician pay are misguided. That said, I think the only place for the free market in healthcare is cosmetic/elective procedures. This isn't retail and our patients aren't customers.

 

[Dharma]

Healthcare may be of a higher calling, but it is also business. Patients must be treated in a caring way that goes well beyond (average) retail… but they are customers as well.

Having looked at some of the DPC practices that are popping up out there, I'm not so sure that the economically disadvantaged could not afford such services. I mean, I've seen some dirt poor folks rolling around with iPhones for the whole family… would they be able to afford a monthly payment (~$100 month for the entire family; see link below) seen in DPC models? Maybe a model could be created that could provide for the poor. I don't know; it's something I need to research and think about.

But I disagree that patients are not customers. No, they're not shopping at the GAP, but they are "paying" for a service.

http://neucare.net/pricing/

 

[HeronsBeak]

I don't see anything particular about increased residency slots besides a quick mention. That has to go through Congress and I don't think we will be seeing any massive increase anytime soon. There are plenty of primary care residency slots in East-Bumblef*(k that routinely go unfilled, a lot of which are AOA and now (or soon to be) accessible to all. (Any coincidence in the timing of these events?) I bet those are the first to be filled, because they are just waiting and do not need pass through the dysfunctional sieves that exist in Washington. I know that's a lot of speculation, but it kinda makes sense.

I'd be careful wishing for more residency slots in general though. Saturation could lead us down a road similar to law school grads. Many markets are already saturated. The key is getting people to go become docs in East-Bumblef*(k, which this budget proposal could do. Sign the kids up before they know what they're getting into and force them into residency/post-residency work wherever Uncle Sam sees fit.

Unfortunately the east bumblef,(k karaoke bar in Howe, IN has closed. It appears the east bumblef,(k market has taken a turn
https://foursquare.com/v/east-bumble****-indiana-howe-in/4bbc7f3f51b89c74db73872a

 

[MalachiConstant]

Healthcare may be of a higher calling, but it is also business. Patients must be treated in a caring way that goes well beyond (average) retail… but they are customers as well.

Having looked at some of the DPC practices that are popping up out there, I'm not so sure that the economically disadvantaged could not afford such services. I mean, I've seen some dirt poor folks rolling around with iPhones for the whole family… would they be able to afford a monthly payment (~$100 month for the entire family; see link below) seen in DPC models? Maybe a model could be created that could provide for the poor. I don't know; it's something I need to research and think about.

But I disagree that patients are not customers. No, they're not shopping at the GAP, but they are "paying" for a service.

http://neucare.net/pricing/

I like the direct care model for primary and preventive care in theory, and had considered pursuing it myself at one point. There are success stories out there, and obviously it can work if you have a large enough population of people who are educated, proactive about their health and have enough foresight and disposable income to pay for something they can't hold in their hands. I talked to a lot of people and crunched the numbers and didn't think I could make it work in my particular area.

I'm not one who blames the poor for their plight, but I understand that there is something about being in that condition that creates a need for immediacy which often leads to financially unwise decisions. For the person struggling day to day to pay for food and to cover bills, buying the latest iphone doesn't make sense, but it may provide a boost to their sense of self worth. Nobody want to feel poor, not even poor people. So given the choice of paying that expensive phone bill, or paying me to keep their cholesterol at a reasonable level, they'll pick the former nearly every time.

 

[NontradCA]

It's kind of ridiculous that you're all looking to put a bandaid on a broken system. We need a single payer system. And things are going to go that way eventually. The path to that process is going to hurt physician salaries and quality of life because they do not have the lobbying power of insurance companies and hospital systems. You will see physicians being bought up by hospitals (which is happening rapidly already), and then when the hospitals can no longer sustain the ridiculous cost of healthcare, gov'ment will come in.

 

[GUH]

It's kind of ridiculous that you're all looking to put a bandaid on a broken system. We need a single payer system. And things are going to go that way eventually. The path to that process is going to hurt physician salaries and quality of life because they do not have the lobbying power of insurance companies and hospital systems. You will see physicians being bought up by hospitals (which is happening rapidly already), and then when the hospitals can no longer sustain the ridiculous cost of healthcare, gov'ment will come in.

Single payer will not solve some of the most basic inefficiencies in our healthcare system. We spend a huge chunk of our healthcare dollars on (often futile) end of life care. Simply shifting 100% of the cost to government will not solve this; the culture has to change first.
I agree that we might be going that way though, since the ACA was designed to fail and those who rely on the federal government for "free" food, education, and shelter will probably be likely to push for "free" healthcare as well.
If that happens, I will do everything I can to be in private practice. Because like it or not, there will continue to be patients who are willing and able to pay for high-quality, hassle-free, care. And this is exactly what has happened in other single-payer countries: a two-tiered, mixed private-public system.

 

[GUH]

For the person struggling day to day to pay for food and to cover bills, buying the latest iphone doesn't make sense, but it may provide a boost to their sense of self worth. Nobody want to feel poor, not even poor people. So given the choice of paying that expensive phone bill, or paying me to keep their cholesterol at a reasonable level, they'll pick the former nearly every time.

I can't tell you how many times I've seen people with the most recent Galaxy/Android/iPhone at the homeless shelter while I just have my "old fashioned" flip phone. For them it's the most valuable thing they actually own, so it probably means more to them to have a nice phone than it would mean to me. Not that I condone this kind of spending since it could easily pay a month's shared rent and open up a spot at the shelter for someone who really needs it.

 

[ChrisGriffen]

Yup. People are poor an its their fault. Its nuts that some people have smartphones and food stamps. What dinguses. Shame on them for owning a nice thing.

 

[GUH]

Yup. People are poor an its their fault. Its nuts that some people have smartphones and food stamps. What dinguses. Shame on them for owning a nice thing.

That isn't true of all poor people, or even most.

 

[NontradCA]

Single payer will not solve some of the most basic inefficiencies in our healthcare system. We spend a huge chunk of our healthcare dollars on (often futile) end of life care. Simply shifting 100% of the cost to government will not solve this; the culture has to change first.
I agree that we might be going that way though, since the ACA was designed to fail and those who rely on the federal government for "free" food, education, and shelter will probably be likely to push for "free" healthcare as well.
If that happens, I will do everything I can to be in private practice. Because like it or not, there will continue to be patients who are willing and able to pay for high-quality, hassle-free, care. And this is exactly what has happened in other single-payer countries: a two-tiered, mixed private-public system.

That's a bad example you gave. It will be much less complicated when one entity is controlling the costs. The government wouldn't focus on end of life care, as they wouldn't be in it to make tons of profit. If you don't think the government would have hospitals by the balls you're mistaken.

 

[NontradCA]

That isn't true of all poor people, or even most.

He was being sarcastic. C'mon man. A cell phone is a necessity nowadays.

 

[GUH]

That's a bad example you gave. It will be much less complicated when one entity is controlling the costs. The government wouldn't focus on end of life care, as they wouldn't be in it to make tons of profit. If you don't think the government would have hospitals by the balls you're mistaken.

Do you really think that the our government will effectively control costs?
When it comes to taking every possible heroic effort to make sure everyone's grandparents keep breathing for as long as possible, folks will push politicians hard to make sure that we continue to spend heavily on end of life care, regardless of whether it is a good use of resources. Remember the fabricated "death panels" controversy?

He was being sarcastic. C'mon man. A cell phone is a necessity nowadays.

Yes, but not smart phones.

 

[DocEspana]

The amount of naivete and simplification to the point of absurdity about "free markets" and applied libertarianism is terrifying. Please understand that there is a reason the US was a free market for all of 3 years before Washington changed that. Laissez-Faire hasn't existed in the US since prior to Washington's second term. And there is a reason that the only true free market economies are horrifically unstable and only seen in remote locations known for pirates and warlords rather than patrons and wise leaders.

This is coming from someone who has a double major that includes political science and wrote his senior thesis on the complete disconnect between how logically appealing libertarianism is and how shockingly corrupt and ineffective (yes worse than big government somehow) it is in practice. So I'm a *tad* biased against it.

 

[KnuxNole]

Do you really think that the our government will effectively control costs?
When it comes to taking every possible heroic effort to make sure everyone's grandparents keep breathing for as long as possible, folks will push politicians hard to make sure that we continue to spend heavily on end of life care, regardless of whether it is a good use of resources. Remember the fabricated "death panels" controversy?


Yes, but not smart phones.

But how are they supposed to Instagram stuff and keep up with Facebook/Twitter? Poor people don't want to be social outcasts either!

 

[NontradCA]

Do you really think that the our government will effectively control costs?
When it comes to taking every possible heroic effort to make sure everyone's grandparents keep breathing for as long as possible, folks will push politicians hard to make sure that we continue to spend heavily on end of life care, regardless of whether it is a good use of resources. Remember the fabricated "death panels" controversy?


Yes, but not smart phones.

Well I think since the people controlling the costs now have no incentive for the socioeconomics of it, that there is no conversation for what is best for the patients (and physicians don't have the power here). The government has that responsibility.

 

[DocEspana]

Just for those following at home: if you boil it down to the most basic answer, who is controlling costs and setting payments now: doctors.

Don't forget your reimbursement has been decided* by the AMA. That organization everyone maligns is empowered to set payment schedules and billing systems. "But DocE, insurances decide what you get paid" you say? Well the AMA more or less sets medicare reimbursement. And private insirances more or less are a percentage (almost always >100%) of Medicares base payment. So while insurances base it off of what medicare says (mostly) medicare says what the AMA says it should (mostly). This is a description lacking a lot of the nuance of reality, but ultimately its true.

Just want to make sure when everyone blames the government for poorly controlling this, they realize its not the government controlling this. They empower the gigantic physician group to make the tough decisions for them assuming that physicians will know what is fair distribution of payment better than they will.

*until whenever these performance based reimbursements start. These are new.

 

[touchpause13]

Question for DocE then. You did mention the AMA screwing over primary care docs. How did that go over? I also know that psych is another "low paying" speciality. So did the AMA basically decide that procedures would be reimbursed the highest or am I missing something here?

 

[DocEspana]

Question for DocE then. You did mention the AMA screwing over primary care docs. How did that go over? I also know that psych is another "low paying" speciality. So did the AMA basically decide that procedures would be reimbursed the highest or am I missing something here?

they were basically told that they had to create a billing system. The US wanted to stop using the international coding system as the basis of billing. They wanted one of their own. The reason for this was that international coding system lent itself to high payments for primary care doctors and less for specialist, but the US had already created precedent that it would break from the system to heavily pay a specialist.

so rather than do it lightly, they empowered AMA to create a coding system it felt better represented what should be compensated and how, and the government would create a billing system from that coding system. the AMA historically is very devoid of family medicine doctors, unspecialized internal medicine doctors, and unspecialized general surgeons. the system they created represented the makeup of their own voter body. It even further increase specialist payments beyond what they were getting paid before and it dramatically dropped payments for primary care and general surgery. To the point where specialists can get paid many times more for the same procedure then internal medicine physicians can. the argument for it was a difference in the amount of people a primary care physician can see you today any special can. Which looks good on paper, but doesn't work at all in reality.

so now that drives all of the primary care people out of the AMA, and the government continues to empower them every few years to rewrite the coding system and they always do it in a way that benefits the voting body which actually pays their dues to the AMA. The specialist. They are aware of the issue that this has caused, but frankly it's hard to want to represent the people who fled from you. it's not like there are unlimited funds and they decided to screw over the primary care, it's that someone has to take a pay cut and they are not going to bite the hand that feeds them. there has definitely been attempts to rectify the issue in the last few years, but it is hard to change the momentum they set in motion when they first decided to represent the people who were paying dues rather than the people who fled long before this issue ever began.

 

[DocEspana]

of note, the Affordable Care Act is basically fantastic for primary care. Any doctor who tells you otherwise and he's in primary care is terrified of a boogie monster rather than reality. But it is a serious pain in the ass for specialist. embracing the Affordable Care Act, although they only embrace it as it was originally written not as it has been heavily amended now, was an attempt to reach out to primary care. Whether it works or not is not totally clear since the Affordable Care Act was so heavily modified. But it remains a great thing for primary care even if Some less than ideal things were inserted. But this embrace of the Affordable Care Act has now soured specialist on the AMA. It's really a tough position they represent trying to look out for the well being of two groups that earn money in drastically different ways.

 

[DermViser]

Yet if we don't increase primary care doctors we'll see the nurse lobby having more muscle against Washington. I recommend opening more primary care slots.

Um, they already have. Have you not seen the Nurse Practioner movement? Nurses are already good buddies with Obama.
https://fpb.case.edu/Alumni/notes.shtm

Rebecca M. Patton, MSN ’98, president of the American Nurses Association, led a contingent of nurses in a press conference with United States President Barack Obama in the White House Rose Garden on July 15, 2009. Ms. Patton and President Obama encouraged lawmakers, nurses, and other healthcare professionals across the country to voice their commitment to healthcare reform. A nurse for nearly 30 years, Ms. Patton resides in Lakewood, Ohio, and was elected to serve a consecutive two-year term as president of the American Nurses Association in June 2008. ANA is the nation’s leading professional nursing organization representing the major health policy, practice, and workplace issues of registered nurses. Watch the video.

Patton appears with President Obama to address the American Nurses Association (C-SPAN). From the President's speech:
"I was mentioning to Becky [Patton] the first time we met that when I was in the state legislature I was the chairman of the Health and Human Services Committee, and one of my strongest allies in Springfield, Illinois, the state capital there, was the nurses association. We did a lot of work together to make sure that nurses were getting treated properly, being paid properly, getting the overtime they needed, the time off that they needed, getting the ratios that they needed, and so I have a wonderful history working side-by-side with all of you to make sure we have the best health care system in the world. And, as a consequence, I want to say 'thank you' for all the support you're providing for health insurance reform for the American people. I am so pleased to be joined by all of you. I've said it before, and I'll say it again: I just love nurses."

 

[GUH]

The amount of naivete and simplification to the point of absurdity about "free markets" and applied libertarianism is terrifying. Please understand that there is a reason the US was a free market for all of 3 years before Washington changed that. Laissez-Faire hasn't existed in the US since prior to Washington's second term. And there is a reason that the only true free market economies are horrifically unstable and only seen in remote locations known for pirates and warlords rather than patrons and wise leaders.

This is coming from someone who has a double major that includes political science and wrote his senior thesis on the complete disconnect between how logically appealing libertarianism is and how shockingly corrupt and ineffective (yes worse than big government somehow) it is in practice. So I'm a *tad* biased against it.

Truly free markets never been tried in modern history. And no, countries that lack markets altogether do not count as free markets.
The solution to the government being in bed with groups like the AMA is clearly not to just have a bigger government.
Finally, just who exactly is responsible for not enforcing the ACA as written? The very same folks that fought to have it made into law. Just goes to show how much confidence they have in their own legislation.