How Not to Do A Survey

Mark of New Jersey

Mark is a Founding Editor of The League of Ordinary Gentlemen, the predecessor of Ordinary Times.

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106 Responses

  1. DensityDuck says:

    The only true thing you can say about any poll is that 100% of the people who chose to reply to the poll chose to reply to the poll.Report

  2. MikeSchilling says:

    87.3 % of all statstics cited by pundits are balderdash.Report

  3. Tim Kowal says:

    For the record, the figure always seemed very suspicious to me.Report

  4. Kazzy says:

    “50% of stats on the internet are made up.” – Abraham LincolnReport

  5. wardsmith says:

    My decidedly unscientific survey of my neighborhood doctors (my neighborhood has a LOT of doctors) is exactly as I stated in a post on Tod’s previous OP about healthcare competition. 100% of my neighbors who are able to retire intend to do so. 100%. The young ones have hundreds of thousands in debt to work off and are looking at a bleak future where they will work harder for less reward then their retired neighbors. This is the reality.

    Now there is always the microscopic chance that the same US Government that can’t manage its own finances and can’t agree on a budget will miraculously deliver a fantastic program that does all it has promised and more while dumping 30million new takers into the system. Should that miracle occur, some may choose not to retire. All are grey, most are in their 50’s and could have many productive years ahead of them. All own or co-own practices which are small corporations that are similar to law or accounting firms with partners, associates and so on. They fully expect those entities to go away (some already have being consumed by hospital consortiums).

    As one cardiologist told me recently, “I went into medicine as an entrepreneurial venture. Yes I want to save lives but I also want to be my own boss. This next generation of doctors will all end up working for the government, they not only will not be ‘on call’ they won’t even understand the concept. When their shift is done they’ll leave without a care in the world for that patient who is now someone else’s problem”.Report

    • Jaybird in reply to wardsmith says:

      This next generation of doctors will all end up working for the government, they not only will not be ‘on call’ they won’t even understand the concept. When their shift is done they’ll leave without a care in the world for that patient who is now someone else’s problem”.

      I see this as something that might result in more doctors staying.

      If a policy makes it tougher to be a doctor, we’ll have fewer doctors. If a policy makes it easier to be a doctor, we’ll have more of them.

      The above reads to me like something that would make doctorship easier.Report

    • greginak in reply to wardsmith says:

      “new takers” ….Orwell would be proud.Report

      • MikeSchilling in reply to greginak says:

        It is Orwellian to invent the word “taker” when the perfectly idiomatic “moocher” and “looter” are available.Report

      • david in reply to greginak says:

        Not only that, but the commenter seems to be gleefully ignorant of the fact that these 30 million are ALREADY IN THE SYSTEM. They’re just costing him $500 for an emergency room visit that could be prevented with a simple $50 visit to a doctor’s office. It is amazing how some will argue over the pennies in their front pockets while not caring to notice the dollars being plucked from their back pockets.Report

        • Trumwill in reply to david says:

          Except that emergency visits are a pretty small part of the overall pie (according to McKinsey, in 2006 it was $75b out of $2t, throw in ambulatory surgery centers & DIC and we’re up to one half of one percent). And from what I recall, Massachusetts’ experiment lead to an increase rather than decrease of ED care.Report

        • wardsmith in reply to david says:

          Bzzzt wrong again David (or is it Mavid?). How about the patients who go to the ER because they can’t get in to see their regular doctor? And this is for ostensibly insured patients. Once ACA is in force, the same dynamics will hold, only far worse because there is NO provision to handle the increased load. Primary care physicians will be overwhelmed (they already are). Therefore the same folks going to the ER today will go tomorrow, and create even LONGER lines for everyone. The Bureau of Labor Statistics predicts a need for 145,000 new doctors by 2018, and they weren’t including the physicians who plan to leave medicine early.Report

  6. Tod Kelly says:

    I know it bugs everyone when I speak of the internet in anything but glowing terms, but I think this speaks to a problem I’ve been writing about a lot lately; namely, that with the internet facts have become a commodity that people can select based on pre-determined preferences.

    I think your analysis (and, I guess MM’s as well) is top notch, but I doubt it matters. Those that want those facts to be correct will seek them out and cling to them; those that don’t will find other facts just as specious to cling to for their own part.

    None of which should be meant as trying to take anything away from this post, by the way. It was terrific, as usual.

    (subliminal message: post more!)Report

    • Anderson in reply to Tod Kelly says:

      Couldn’t that be true even before the internet though? Partisans will make BS stats to rally up the faithful by any medium. If I saw more-respected conservative news outlets like the WSJ or (gasp) the Romney campaign using these bogus studies, I would show more concern (though at least they would be called out by the reasonable opposition.) Granted, the Daily Caller is no small player, but as you said: “Those that want those facts to be correct will seek them out and cling to them; those that don’t will find other facts just as specious to cling to for their own part.”Report

  7. Tom Van Dyke says:

    True, bad methodology. The right wing is stupid.

    Back of the envelope, no less than 20%, which as Mighty Joe Biden would say, is still a BFD.—-but-dont-blame-healthcare-reform/

    [No, of course not, CBS. Great headline. Read no further!]

    According to the survey of 100,000 practicing physicians:
    Forty percent of doctors plan to stop providing patient care within three years. They will retire, seek a non-clinical job within healthcare, or leave the healthcare field entirely.
    Seventy-four percent will make significant changes in their practice in reaction to reform.
    Sixty percent of respondents say reform will force them to close or restrict their practices to certain subgroups of patients. Of these, 93 percent say that decision would affect Medicaid patients, and 87 percent say they’d exclude some or all Medicare patients.
    Fifty-nine percent of doctors believe that reform will cause them to spend less time with patients.
    Sixty-eight percent think reform will reduce the viability of their practices, and a whopping 80 percent say that it will hurt private practice specifically.
    While 34 percent say that reform is the factor that will have the greatest impact on their practices in coming years, 36 percent say the same of Medicare’s current payment methodology, which threatens doctors with a 30 percent reimbursement cut in 2011.
    The survey report doesn’t state what percentages of respondents are in practices of various sizes. But 59 percent are in physician-owned practices, which is higher than the overall percentage of doctors (48 percent) who remain independent, according to the Medical Group Management Association. So, the researchers admit, the results are slanted somewhat in favor of private practitioners. Large groups of employed doctors are more likely to favor reform because they’re better prepared for it. Tellingly, 68 percent of the respondents oppose payment bundling, which will work far better for large organizations than for small practices.Report

    • Oh, and the young docs think it sucks too.

      BOSTON, Apr 11, 2012 (BUSINESS WIRE) — Fifty-seven percent of young physicians (40 years of age and under) are pessimistic about the future of the U.S. healthcare system, according to a new survey by The Physicians Foundation, a nonprofit organization that seeks to advance the work of practicing physicians and improve the healthcare system in America.

      Young physicians cited “the new healthcare law” as the leading reason for their pessimism. Specifically, when asked about the Affordable Care Act (ACA), nearly twice as many respondents believe that the legislation will hurt their practices compared to those who think it will have a positive effect (49 percent and 23 percent, respectively). Conversely, only four percent are “highly optimistic” about the ACA. Other reasons cited for physician pessimism include concern over increased regulatory burdens and medical liability insurance premiums.

      “Our nation needs the best and brightest going into medicine. Therefore it is critical that we pay close attention to the sentiments of America’s next generation of physicians,” said Lou Goodman, Ph.D., President of the Physicians Foundation and CEO of the Texas Medical Association. “The level of pessimism among young doctors today is troubling and reinforces the notion that physicians need to be key participants in health policy discussions.”Report

      • Sam Wilkinson in reply to Tom Van Dyke says:

        “Hi, I’m one of the best and the brightest and I’d like to be a doctor.” Student Somewhere

        “Do you know you might have to take care of poor people?” Somebody

        “I might? Never mind then. I’m not in this to take care of poors.” Student Somewhere.Report

        • Jaybird in reply to Sam Wilkinson says:

          “Well, I was going to get a degree in Social Work, but now that I know that I’m going to be helping the poor, I’m instead going to get a degree in Medicine.”

          If we can get enough people to say that, imagine how many people we could help!Report

        • “Mr. Wilkinson, I’d like you to meet Dr. Larry the Cable Guy. He’ll be doing your hysterectomy today, sometime between 8:30 AM and 5 PM.”Report

        • wardsmith in reply to Sam Wilkinson says:

          Let’s see. Just to get accepted into one of the 146 Medical Schools you have to show a 4.0 GPA throughout most of your schooling (going back to High School). No easy-A classes you have to show competence (read A’s) in Chemistry, Biology, Physics, Calculus and so on. Now you have to pass the MCAT with a sufficiently high score to beat out those other test takers (there are far more applicants than openings). Then you get to add the burden of hundreds of thousands in student debt. Then you have 4 years of grueling medical schooling, followed by at least 4 more years of grueling internship then residency (much longer for certain specialties). You will be paid peanuts while you “do your time” as an intern then resident. You will not be able to afford a house, you will work ungodly hours and you will STILL need to pass your boards when you’re done (taking time off to study won’t cut it, you have to work that into your 18 hr workday if possible otherwise, well who needs sleep?). You’ll also be in mortal fear that your career will prematurely end because you made a mistake on a patient while too exhausted to think straight.

          Naturally when you’re done you should pay back society by doing nothing but pro-bono work on the destitute. Or I don’t know, party hearty all through college getting an easy journalism degree and bitching about how easy doctors have it.Report

          • Mo in reply to wardsmith says:

            Sounds to me like there’s an undersupply of medical schools which is leading to upward price pressure. I wonder what group of people would have an incentive to have med school spots grow at half the rate of the population growth in the last 30 years. It’s probably those dastardly journalism students.Report

            • Jaybird in reply to Mo says:

              How difficult would it be to open a new medical school or hundred?

              If it’s more than “not particularly”, there’s a problem. We should have medical schools sprinkled across the country like they were Regis or University of Phoenixes or National American Universities.

              There’s no reason we can’t turn the sentence “Just to get accepted into one of the 146 Medical Schools you have to show a 4.0 GPA throughout most of your schooling” into “Just to get accepted into one of the 346 Medical Schools you have to show a 3.7 GPA throughout most of your schooling”.Report

              • Tom Van Dyke in reply to Jaybird says:

                Here’s some truthy factoids from USA Today:

                The country needs to train 3,000 to 10,000 more physicians a year — up from the current 25,000 — to meet the growing medical needs of an aging, wealthy nation, the studies say. Because it takes 10 years to train a doctor, the nation will have a shortage of 85,000 to 200,000 doctors in 2020 unless action is taken soon.


                The predictions of a doctor shortage represent an abrupt about-face for the medical profession. For the past quarter-century, the American Medical Association and other industry groups have predicted a glut of doctors and worked to limit the number of new physicians. In 1994, the Journal of the American Medical Association predicted a surplus of 165,000 doctors by 2000.Report

              • Trumwill in reply to Tom Van Dyke says:

                In 1994, the Journal of the American Medical Association predicted a surplus of 165,000 doctors by 2000.


                (Seriously, despite the fact that I repeatedly make the point that the AMA is not a cartel, they have a lot to answer for. Not just them, but including them.)Report

              • Will Truman in reply to Jaybird says:

                Jaybird, it’s much more than “not particularly.” Medical schools are really, really expensive. They’re not profit centers like law schools can be. Montana and Idaho both want medical schools, but neither can get from Point A to Point B and not really because of LCME intransigence. Really, the LCME isn’t even necessary to set on a DO school. But you have to get faculty, facilities, and all sorts of other capital investments. My own alma mater has long-wanted a medical school, but can’t get there. This is a school with an annual budget of over a billion dollars a year, a nine-digit endowment, a track record in a related field, excellent graduate programs in engineering, and numerous top 100 rankings. A medical school, however, remains out of reach.

                This would be particularly difficult for any for-profit institution, because hospitals would likely not be inclined to work with them and potential faculty would not want to work for them.

                With each passing year of medical school, there is (or at least was, for the wife) a shift away from the classroom and more towards hospital work.

                In any event, medical schools are not actually the bottleneck. Increase the number of medical schools (or the number of students accepted into them) and you’re mostly just crowding out imported doctors. If you want to increase the number of doctors, you have to either increase the number of residency slots or establish an alternate route to practice that does not involve residency.Report

              • Jaybird in reply to Will Truman says:

                establish an alternate route to practice that does not involve residency.

                Put up a shingle?Report

              • Jaybird in reply to Will Truman says:

                I mean, this is crazy. We’ve got a situation where we need tens of thousands of more doctors and our medical schools are maxed out, we can’t make more, we can’t even speed up how we make them, and the only option that is really open to us is to make promises of coverage to millions of people.Report

              • Sam Wilkinson in reply to Jaybird says:

                Can somebody explain how denying healthcare to millions of potential customers increases the number of doctors?Report

              • Jaybird in reply to Sam Wilkinson says:

                “Coverage” and “healthcare” are two entirely different things.

                Increasing the one without increasing the other will have predictable results. But you’ll get to watch that one in real time.Report

              • Sam Wilkinson in reply to Sam Wilkinson says:

                Okay, how will bankrupting millions of Americans produce more doctors?Report

              • Jaybird in reply to Sam Wilkinson says:

                I’m not sure that “bankrupting millions of Americans” was ever anyone’s goal or even preferred method of doing anything.

                If, however, you wish to play that game, I’ll ask you whether bankrupting thousands of doctors will help anybody.

                Let me know when you get sick of that and maybe we could then start hammering out what our goals actually are, whether they’re measurable, and whether our preferred policies will move us in a measurable direction toward our goals.Report

              • Mike Schilling in reply to Sam Wilkinson says:

                I’m not sure that “bankrupting millions of Americans” was ever anyone’s goal

                The Hunt brothers did their best.Report

              • Sam in reply to Sam Wilkinson says:

                And yet, one side of this conversation advocates for policies which bankrupt millions of Americans. We know that health care is hugely expensive here (as opposed to other countries with better healthcare systems). We know that people who can’t pay for health care still NEED health care from time to time. We know that the Republican plan to deal with this problem is absolutely nothing at all (other than collectively standing against their own policies). So how can we say, “Well, bankrupting people isn’t the goal!” with a straight face?Report

              • Jaybird in reply to Sam Wilkinson says:

                And when you see what the Heritage Plan has as some of its own unintended consequences, will the argument change to one of intent?

                Will you instead point out that it would have worked were it not for the Libertarians and other wreckers?Report

              • Sam in reply to Sam Wilkinson says:

                What do you prefer that people who cannot get coverage do? What is the proposal for that aspect of the current marketplace?Report

              • Jaybird in reply to Sam Wilkinson says:

                There are two ways to ration a scarce resource:

                A) By Price
                B) By Queue

                The latter feels more “fair”, I suppose, but is much less likely to result in a larger pool of a creatable scarce resource than the former.

                If one is more interested in “coverage of health care” than “provision of health care”, I can see the second as being more soothing to one’s troubled conscience.Report

              • Sam in reply to Sam Wilkinson says:

                Are you using “Queue” here as a synonym for need? Because, in health care, it seems obvious that the need for it MIGHT be a way to ration it.Report

              • Jaybird in reply to Sam Wilkinson says:

                No, it’s a synonym for “getting in line”.Report

              • Sam in reply to Sam Wilkinson says:

                Can I assume you prefer the system in 2007 to the direction in which we are headed?Report

              • James Hanley in reply to Sam Wilkinson says:

                Although I can’t speak for the bird, that’s not necessarily a safe assumption. It could be like asking, “Do you prefer to keep driving on this path and go over the cliff or would you prefer to make a right turn into the path of that semi?”

                Or to be more highbrow, a false dilemma.Report

              • Sam in reply to Sam Wilkinson says:

                If it is a false dilemma, then what direction would you like to go? (I’d prefer various European models…)Report

              • James Hanley in reply to Sam Wilkinson says:


                Yes, the Euro model is an alternative. So is the Singapore model. So is an actual free market model. So is the HCA model. I’m not going to argue for any of them, since I don’t have a settled opinion on this. I just think that throughout this thread you’ve been uncharacteristically uncharitable in your interpretation of what others are saying.Report

              • Sam in reply to Sam Wilkinson says:


                I think what matters (hugely) is what is realistic to implement. However, if my responses have come off in that way to you, I will simply bow out of this conversation. I do not (always) intend to be uncharitable. My own cynicism informs my opinions and perhaps, left uncheck to fester, it has gotten out of control. I am suspicious of this, but will consider it in my absence. Apologies to those that I might have offended.Report

              • Jaybird in reply to Sam Wilkinson says:

                Ahhhhhhh! Some of the comment threads from years past have been raptured!

                In any case, there are still a couple of comment threads that have some remnants of the essays I wrote.Report

              • James Hanley in reply to Sam Wilkinson says:


                For the record, I am not encouraging you to bow out of the conversation. Absolutely, unequivocally, not doing that. Take a break to ponder, by all means, if you feel you need to, but please don’t feel pushed out.Report

              • Will Truman in reply to Jaybird says:


                I have to think that *something* could be worked out. Not hanging out a shingle, but… *something*. Maybe treating foreign-trained physicians (FTP) like a type of Mid-Level Provider where they work at an established hospital/clinic or two for ten or so years and then get full licensure. I dunno… something.

                GP’s used to not have residency. Now they do. I thought, for a while, maybe we could go back to the old way. However, any doctor I’ve mentioned this to has been emphatic about it. Even doctors who are drowning in their workload and want more doctors very badly. It’s not an immediate self-interest thing. It could be a pride thing, but I don’t feel particularly qualified to tell them they’re wrong.

                This is totally anecdotal, but by and large the MLP’s my wife works with actually have more legal latitude than capability (ie, she is likely to be called in on something that the MLP can legally do, but doesn’t feel comfortable doing), at least in an ER setting. The FTP’s might need more supervision than a PA or NP (the level of consultancy with the former sometimes being a joke, the latter sometimes not even needing consultancy at all), yet also may be confident enough to do more.

                I actually wonder if it will come down to MLPs, in the end. I suspect that what’s required to get one of those programs up and running is a lot easier than a med school (I mean, there are already more PA schools than med schools). Flood the market with those and the doctors act in a moderately more supervisory capacity, seeing patients but also dealing with the things MLP’s need assistance with. It sort of bypasses the institutional locks on the system, allows us to have a lot of providers who get paid less, and so on.

                The problem, of course, is that I think we have a shortage of providers at every level. My wife worked at her current job for two years before she got a nurse rather than a medical assistant. Clancy’s hospital wants PA’s, but is having a hard time recruiting them.

                I do have to confess, this whole comment may be ludicrously ignorant. These are based on impressions I have looking from outside the window of, but not working in, the medical profession. But these are my impressions all the same.Report

              • James Hanley in reply to Will Truman says:

                actually wonder if it will come down to MLPs, in the end.

                I think that’s very much a necessary course of action. We obviously can’t create enough “real” physicians, and there’s a lot of stuff that doesn’t really require the capabilities of an actual physician. I’m getting a cyst on my foot looked at today–medical school and residency is a bit of overkill for that, nonetheless the doctor will have to spend some time with me.

                The problem, of course, is that I think we have a shortage of providers at every level

                Except Hollywood plastic surgeons. Yes, this is what needs to be addressed, and it probably needs to begin with better science education in K-12. My friend who heads my college’s pre-health institute regularly deals with students who want to go into the health professions but are scared of anything to do with science.

                I do have to confess, this whole comment may be ludicrously ignorant.

                And you’re married to a doctor, so what does that say about my comment? 😉Report

              • With regard to the Hollywood surgeons, it’s worth noting here that when some people (less here, but it’s more common in other circles) talk about how with single-payer we will be able to bargain fees down and doctors will just have no choice but to accept whatever we will give them, we often overlook the options they do have. Here, we’re talking about the possibility of early retirement, but another possibility is tertiary medical markets. My wife was called by a headhunter to do light plastic surgery at a spa in Oregon. I asked my wife if that was something she could do even if she decided to, and she said that it was. She wouldn’t be comfortable doing it (and not just because that’s not the kind of medicine she wants to practice) but it wouldn’t take much training before she did become comfortable doing it. The foundation of the skills are already there. The foundation is there for a lot of other things, if it came down to it.

                (I would also argue that, if we had Medicare-for-All without other significant reforms, the market for off-Medicare medicine would skyrocket. People of means simply wouldn’t want to wait in line, concierge clinics would increase, and so on.)Report

        • James Hanley in reply to Sam Wilkinson says:

          @Sam W.

          “Hi, I’m one of the best and the brightest and I’d like to be a doctor.” …
          “Do you know you might have to take care of poor people?” …
          “I might? Never mind then. I’m not in this to take care of poors.” …

          I’m not sure what to make of this, but it seems to me that it fails to take incentives into account. Let’s say this student is motivated primarily by money, and that there are others like him. Take away that incentive, and those people don’t become doctors. Granted, in a perfect world we’d like all doctors to be motivated by the desire to help, and each of us would like our own doctor to actually care about our well-being, and not just the depths of our pockets. Still, fewer doctors is fewer doctors, and better to have a doctor who are coldly efficient and refers to you as Patient 793-H1 than to not have a doctor.

          Remove those doctors–who we can assume aren’t treating the poor–and you don’t end up with fewer doctors for the well-off and the same number as before for the poor. You just make more room for other doctors to move into caring for the well-off, and fewer for the poor. Because doctors are only human, and for most of them, even those who do actually have human feelings of care for those they treat, better pay and a “nicer” clientele are preferable. It’s a rare doctor who sees his/her job primarily in the role of missionary.Report

          • Jaybird in reply to James Hanley says:

            Maybe if we gave doctors a union, we could go back to talking about how selfless they are.Report

            • James Hanley in reply to Jaybird says:

              Just like us teachers!Report

            • Mo in reply to Jaybird says:

              Isn’t that called the AMA?Report

              • James Hanley in reply to Mo says:

                No, the AMA doesn’t do anything like collective bargaining, and if a doctor gets fired, the AMA isn’t likely to go to bat for them, so far as I know.Report

            • Chris in reply to Jaybird says:

              I am not a fan of doctors as a group — I think it’s a profession that attracts only slightly fewer assholes than the police force, and significantly more greedy, arrogant pricks — but a union might help solve some of the labor issues with residency internships.Report

              • Jaybird in reply to Chris says:

                I find myself wondering if this is satire.

                As such, well done.Report

              • Chris in reply to Jaybird says:

                Nope, it’s not satire, but thanks anyway.

                I’m not sure which part you find odd: that I think doctors are greedy, prickish assholes in general, or that a union would help with some of the labor issues associated with residency internships. If it’s the former, I suggest surveying 100 employees of doctors, especially non-nurses. If it’s the latter, well, when you’re dying and some guy who’s a year out of med school and has been working for 24 hours straight (and for 36 of the last 48 hours) is trying to save you in the ER, good luck with that.Report

              • Jaybird in reply to Chris says:

                It’s more the former than the latter. (I completely agree with the idea of residency being insane, for the record… I’m shocked that we think that anything past, oh, 5 tens in a week would result in anything but mediocrity and certainly for something as important as healthcare.)

                When it comes to greed or prickishness, I’ve not noticed any particular distinction between “doctors” and “professors” or “IT Professionals”. While it’s probably true that people with very broad vocabularies are better at being condescending than people with poor vocabularies (what’s a vocabulary for?), I don’t know that I’ve noticed a particularly high degree of jerkishness in any particular vocation outside of the Prosecutorial.Report

              • Chris in reply to Jaybird says:

                I think academia is sort of like a breeding ground for assholes. I think medicine is more like fly paper for them.

                Again, though, I’d recommend talking to their employees, or comparing the opinions of those who work for doctors with those who work in academic departments.Report

              • Jaybird in reply to Jaybird says:

                Where you see the breeding grounds, I just see tons of people.

                This is a people problem in general.

                I mean, talk to the employees of Domino’s, or Walgreens, or Ace Hardware. I reckon you’ll find ubiquity.Report

              • James Hanley in reply to Jaybird says:

                When it comes to greed or prickishness, I’ve not noticed any particular distinction between “doctors” and “professors”

                You’ve checked out Chris’s “Rate My Prof” page, too? 😉Report

              • Chris in reply to Jaybird says:

                When employees at Domino’s have as much power, we’ll talk about them.

                That said, again, talk to the employees.Report

              • Jaybird in reply to Jaybird says:

                That’s what I meant. Talk to them about their managers and/or bosses.

                If you’re a reader of Penny Arcade, you know about their Trenches comic. Read the “Tales from the Trenches” that they publish under each comic. You’ll boggle.Report

          • Sam in reply to James Hanley says:

            What working doctor out there is earning a bad paycheck? Where are these doctors relying on public transporation and subsisting on foodstamps, living in shelters and begging on street corners?

            I guess what I’m trying to say is that I don’t entirely understand the argument as it is being constructed, which goes, “Hey, some doctors don’t want to treat poor people, so let’s exclude poor people from the system, damning them either to bankruptcy or death.”Report

            • James Hanley in reply to Sam says:

              That doesn’t at all appear to me to be the argument that’s being constructed. Especially when people are arguing for ways to make health care less expensive through competition. Maybe they’re wrong about how it will work out (I’ve got no qualms saying health care seems to have elements that make it more susceptible to market failure than many other products/services), but they’re arguing that it will work out, because markets in general are a huge boon to the poor. So they could be wrong, but they’re not arguing for excluding poor people from health care.

              You’re being quite unfair in your reading of them. You’ve made an interpretation that makes it easy to demonize them, rather than addressing what they’re really saying.Report

              • Sam in reply to James Hanley says:

                I suppose I am being unfair, but I’m doing so in the face of an argument that is contructed, implicitly, to damn vast numbers to the following decision: go bankrupt acquiring medical treatment or suffer. I’m not at all certain why THAT is a policy that ought to be embraced and endorsed and yet it is the preferred one of for an entire political party, as well as numerous wonks and commentators.Report

              • James Hanley in reply to Sam says:

                an argument that is contructed, implicitly, to damn vast numbers to the following decision: go bankrupt acquiring medical treatment or suffer.

                No, Sam, that’s BS. They’re arguing for a change in the system–not the status quo–that they think will make health care more affordable, even for poor people. And not a damn one of them has argued against helping out folks at the bottom end who can’t afford it even in conditions of reduced cost.

                You seem to be taking what you think is the likely outcome and suggesting they don’t care about that outcome; but they don’t see that as the likely outcome.

                This is why Jaybird’s question about whether you’ll respond to the unintended consequences of PPACA by assuming they were intended is so relevant.

                By all means argue that your debate opponents are wrong about the outcomes, but stop accusing them of actually being satisfied about outcomes that they don’t think their proposals would produce. All you’re doing in that case is arguing past them, or even more precisely, substituting cheap moral condemnation for an actual argument about the accuracy of their arguments.

                The precise reversal of your criticism would be, “why don’t you care that PPACA will dramatically reduce the number of physicians?” It’s a nonsense claim about you because you don’t think that will happen (I assume); but that’s exactly what you’re doing to them.Report

              • Sam in reply to James Hanley says:

                I respect what you’ve written here, but I disagree. I do not believe that opponents of healthcare reform are arguing in good faith. I do not believe that they have any interest in fixing the problem, both because they have no political interest in doing so and because they largely don’t believe that a problem exists. I believe that the folks we are discussing believe poverty is a self-generated condition, and that whatever comes along with it a deserved outcome, be it illness or bankruptcy or both. Further underpinning this belief is the policy they’d endorsed for years as a solution to the problem (one which forced individuals to be responsible) was abandoned as soon as the other side said, “Fine, let’s do this your way!”

                The reality is that healthcare advocates could IMMEDIATELY back every single heathcare reform opponent proposal (whatever they are right now: lawsuit reform and cross-state marketing come immediately to mind) and those opponents would suddenly decide that the real policy fix was single-payer healthcare.

                If this is cynical, so be it, but I see no reason to believe, in the face of a mountain of evidence suggesting otherwise, that healthcare reform opponents are being genuine in their analysis and diagnosis of this particular situation.Report

              • Patrick Cahalan in reply to Sam says:

                I’m a healthcare reform opponent, in the sense that I oppose the current iteration of healthcare reform.

                I have an interest in fixing “the problem”, to the extent that I do believe that some aspects of the problem are indeed fixable… and I have less to no interest in fixing the other aspects of the problem because I don’t believe they are, in fact, fixable.

                To some extent I’m a believer in your implicit argument here that many of the specific, out-there, currently-in-office opponents of health care are indeed as you describe, but I don’t think that those people are here, arguing with you, right now.Report

              • James Hanley in reply to Sam says:

                I do not believe that opponents of healthcare reform are arguing in good faith. I do not believe that they have any interest in fixing the problem

                I’m sure there are some like that, but it sounded an awful lot like you were talking to folks here at the League.

                And is there an implicit “all” in front of “opponents?” Because that’s a pretty damned wide brush you’re painting with.

                And “opponents of reform” is also pretty broad; as Pat shows there are “defenders of the status quo” and “opponents of this reform measure,” and those two groups are not identical.Report

              • Sam in reply to Sam says:

                Perhaps not, but this thread doesn’t seem to be discussing the policy alternatives. Perhaps that is my fault (although not entirely). I’m happy to read to a conversation about that.Report

              • Sam in reply to Sam says:


                I was responding specifically to two things: the idea that doctors can’t get paid and the idea that if doctors are opposed to healthcare reform then it simply shouldn’t go anywhere.

                When I wrote healthcare opponents, I was referring to politicians and pundits and media organizations.

                I apologize if I have been unclear in that.Report

              • James Hanley in reply to Sam says:


                I think you’ve misrepresented both of those ideas. Is anybody actually saying doctors won’t get paid? Or are they saying doctors’ pay is likely to be reduced sufficiently to diminish the attractiveness of the profession, resulting in fewer doctors? Those are two very different things; one is utterly ridiculous, and the other is not. If you’re interpreting a non-ridiculous argument as the ridiculous one (or treating the non-ridiculous argument as though it is ridiculous), then I’m still going to say you’re doing it wrong.

                And while doctors’ opinions aren’t the only ones that matter in doing health care reform, since they’re the ones who will either stay or pack up and leave, paying attention to them is pretty damned important, because we won’t be doing a damned a whole lot of good for the poor if we significantly reduce the number of doctors available.

                That’s not to say that will happen as a result of PPACA, and it’s sure as heck not to defend the “findings” of this ludicrous survey; it’s just to say that the response of the regulatory target matters a whole hell of a lot when doing regulation. Hanley’s first law of public policy is, “don’t focus just on the outcomes you want; think about the incentives you’re creating.”Report

              • Roger in reply to Sam says:


                Over the last few days at the LoOG we have repeatedly discussed both policy alternatives and what the nature of the problem is.

                Based upon the nature of the problem, the logical conclusion is to go in the opposite direction to Obamacare. It is not enough to “do something” when there is a problem. You need to do something that doesn’t make the problem worse.Report

              • Sam in reply to Sam says:

                Roger –

                Our definition of worse might be different (which makes this conversation even more complicated).Report

              • Roger in reply to Sam says:


                Ok, cool. How do you define the problems and what are your solutions? Let me know yours, and I will gladly link to my answers to both.Report

              • Stillwater in reply to Sam says:

                You need to do something that doesn’t make the problem worse.

                I’m not sure it’s been established that the ACA makes things worse, full stop. It makes things worse according to some of your favored metrics, some of which I concede. But if the goal is to get universal coverage, guarantee issue and community rating, you must have a mandate (or a tax on those who don’t participate) in order to prevent free-riders from undermining those goals, as well as to generate enough revenue to continue to effectively subsidize end-of-life care.

                Now, we can tweak the parameters of end of life care (death panels!), and we can eliminate EMTALA, and we can dismantle Medicare as we know it so that the elderly effectively face market forces to get health insurance or healthcare provision, but those are huge issues which act as a constraint on what’s politically possible.Report

              • Roger in reply to Sam says:


                I respectfully disagree. I want universal safety nets and affordable coverage too.

                However, I start by analyzing what is wrong with the market. My conclusions were that 1). We disconnected payments from benefits. This eliminates market incentives to be efficient and creates incentives for waste and over use. 2). We were merging a safety net into a market and thus prostituting and destroying both. And 3). We were attempting to use top down master planning to control a decentralized market and destroying the mechanism.

                If these are at all correct, then Obamacare will make all three factors worse. Thus it is a bad solution. It is a worse problem dressed up as a solution. It will lead to increased costs, artificial limits in coverage, greater inefficiencies, lower GDP, more unemployment, greater deficits, higher taxes, a lower standard of living and less medical innovation.

                I suggested a better alternative which addresses all three concerns and does a better job of addressing affordability and universal coverage, and does it without coercion.Report

    • Mo in reply to Tom Van Dyke says:

      I’m sure the end result will be similar to the 70% of Hollywood that was moving to Canada if Kerry lost in 2004.Report

      • Mike Schilling in reply to Mo says:

        Or all the financial types who would have abandoned their profession if bailed-out companies had cancelled bonuses.Report

  8. Jaybird says:

    A handful of questions I wouldn’t mind seeing answered:

    What’s the average age of a doctor out there?

    How old is the average freshly-minted doctor (let’s assume post-residency and post everything that would allow a doctor to have his or her full fledges)?

    Compared to years past, are these numbers more or less in line? If they’re moving, are they both moving in the same direction? If they’re both moving in the same direction, is this direction to the right?Report

  9. Just for the record, my office staff would probably shred a fax like that without bothering to bring it to my attention.Report

  10. This discrepancy serves to demonstrate the degree of self-selection involved with this survey, as internists are, generally speaking, the specialty most likely to support Obamacare, while primary care physicians are the least likely to support it.

    Sorry, should have collected my thoughts into one comment. Internists are, at least in my understanding of the term, considered primary care providers. Many subspecialize, of course, but general internal medicine is a primary care specialty.Report

  11. Kazzy says:

    What percentage of folks in any industry would insist they are in the verge of quitting if given an anonymous, non-binding opportunity to do so? I know a ton of teachers who insist they’d quit tomorrow if X happens. Often, X happens. Almost all those teachers are still teaching.Report

    • Patrick Cahalan in reply to Kazzy says:

      I tell ya, I win the lottery… well, I’m not quitting tomorrow. I have enough professional pride that I’d want to stick around and help my employer find a competent replacement. But I’d be a lot more blunt 🙂Report

      • wardsmith in reply to Patrick Cahalan says:

        Would having a million or two in the bank qualify for you as “winning the lottery”? Many physicians have a net worth north of that. Here’s how it breaks down:
        Intern – residency: $30-50K per year coupled with crushing debt and heinous workload for 4-8 years.
        Practicing physician: The lower residency specialties command the lower annual compensation let’s say $150K/yr. A competent healthy doctor can expect to practice for 20-30+ years after residency. The longer residency specialties like neurology and cardiology command pay in the $350-500K/yr range. Twenty years of that and you HAVE won the lottery. Some astute investments along the way and you’re quite comfortable.

        My son used to work at Microsoft. They have a syndrome there that’s essentially, too rich to work. At some point the annual salary is dwarfed by the net worth and you just don’t give a shit anymore. He got sick of that so went to Google. Guess what is happening at Google now? In business there is always a risk/reward ratio, but to an employee it is more hassle/reward. I don’t blame doctors for anticipating that the future hassles of ACA are going to dwarf the future (diminishing) rewards of practicing medicine. Thinking like businessmen or employees they’re likely to want to quit.

        I know a pediatrician who still practices (part time) and he’s 86. Of course he “sold” his practice decades ago, so he collects money from the physicians who bought it. Along with some other doctors he purchased the (large) building where their offices were so he’s a landlord too. He has invested steadily in stocks and bonds forever and has a pretty lucrative portfolio now. He doesn’t practice medicine because he needs the money by any means, he truly loves pediatrics and loves the children (and they love him). I’m thinking things wouldn’t be the same if he were for instance a proctologist.Report

        • BlaiseP in reply to wardsmith says:

          Heh. Dave Barry’s wonderful “A Journey into my Colon — and Yours

          After an action-packed evening, I finally got to sleep. The next morning my wife drove me to the clinic. I was very nervous. Not only was I worried about the procedure, but I had been experiencing occasional return bouts of MoviPrep spurtage. I was thinking, ”What if I spurt on Andy?”* How do you apologize to a friend for something like that? Flowers would not be enough.

          * his friend Andy Sable, a gastroenterologistReport