How Government is Destroying the Medical Profession: Q&A with Dr. Jeffrey Singer

Doctors are being reduced to shift-workers, who spend a lot of their time doing data entry

"Over the past 30 to 40 years, government involvement in medicine has resulted in a progressive regimentation of the industry," says Dr. Jeffrey Singer, a general surgeon who's also an adjunct scholar at the Cato Institute. "Doctors are being reduced to shift workers who are compelled to follow guidelines and protocols that tell them how to practice and they spend a great amount of time entering data into computers."

Reason's Matt Welch caught up with Dr. Singer at this year's FreedomFest to discuss his article from the May 2013 issue of the magazine, "How Government Killed the Medical Profession: As health care gets more bureaucratic, will doctors go Galt?"

Held each July in Las Vegas, FreedomFest is attended by around 2,000 limited-government enthusiasts and libertarians. Reason TV spoke with over two dozen speakers and attendees and will be releasing interviews over the coming weeks. Go here for an ever-growing playlist of this year's interviews.

About 6 minutes.

Edited by Jim Epstein. Camera by Paul Detrick and Tracy Oppenheimer.

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  • ||

    It wont be just Docs going Galt. I know at least a dozen professionals who have already.

  • Live Free or Diet||

    I sold off my business to a competitor and went part time 4 years ago. I could take all the regulatory crap well enough. But I was shelling out more to the government than to my employees and me.
    I was supporting people I despise more than the ones I collected around me on purpose.

  • ||

    I wish this comment could be broadcast nationwide on every channel and put on billboards in every town.

    Sadly, you would be branded a racist wrecker.

    What was your business?

  • AlmightyJB||

    First

  • AlmightyJB||

    Doh!

  • ||

    Heh. I snatched the coveted first comment right from under your fingertips.....so close!

  • ||

    Thou shalt not covet your neighbor's comment.

  • ||

    Thou shalt have no other blogs before H&R.

  • ||

    Thou shalt not take the name of Lucy in vain.

  • ||

    You shall not troll.

  • ||

    You shall not sockpuppet.

  • Palin's Buttplug||

    So NewsMax likes the Huckster in 2016? (see feed)

    Huck has the SoCon cred to make it happen.

  • John||

    http://www.youtube.com/watch?v=GuGtxt84wPQ

    Looks like somebody won his involuntary commitment hearing yesterday.

  • Palin's Buttplug||

    John, why do you have to piss all over a good thread?

    With me here the never-ending circle jerk is broken and the chance a good discussion ensues is enhanced.

  • John||

    Because you are a sick disgusting sock puppet sent here to fuck up the board.

    Fuck you and die.

  • everyone||

    Without Shrike, no thread would be good.


    Palin's Buttplug| 9.2.13 @ 5:57PM |#

    If everyone agreed with me I would quit posting.
  • John||

    One thing no one ever talks about is the higher education bubble. We drove up the price of higher education over the last 50 years by what, ten fold? It is no surprise that the cost of medical care, a good which requires the services of people with lots of higher education, has gone up as well. That is not the only reason, but it certainly didn't help.

  • Cdr Lytton||

    http://youtu.be/YVFy4ynwoPI

    HT to Pro Libertate whose mention of the Coz led me to this one.

  • Eduard van Haalen||

    Dr., Dr., give me the news, with the govt taking over medicine we're all screwed, lol

    apologiestorobertpalmer.com

  • Palin's Buttplug||

    The government took over all of medicine? When?

    You don't mean by opening a health insurance exchange, do you?

  • John||

  • everyone||

    Agreed. They didn't take over all of medicine.


    Palin's Buttplug| 9.2.13 @ 5:57PM |#

    If everyone agreed with me I would quit posting.
  • Blinded by the Derp||

    Sadly, a few healthcare providers in a forum I visit either A. don't recognize the expansive governmental overreach into government that is almost wholly completely unnecessary (professional group oversight would be much better) B. want socialized medicine

    At least those providers tend to live in progressive hellholes like Minnesota and Massachusetts anyway

  • Jake W||

    b..b..b..but we need to do SOMETHING!

  • From the Tundra||

    Drone strikes on docs who won't tow the lion?

  • ||

    ^This, unfortunately, is what the people say. I was talking to some people on Facebook the other day who have pretty severe allergies (peanut and/or pet dander), and they are still convinced that Obamacare is the only reason they have any access to health insurance, even as it is incredibly expensive.

    They just couldn't wrap their heads around the idea that cutting out MORE middlemen will benefit them. Prescription drugs (SLD: no prescription required) would be cheaper if bought directly, appointments might be "more expensive" in the short term but without costly monthly insurance that is going to standard check-ups it would ultimately be less.

    I spent and hour and a half on the phone with an insurance provider the other day because I said I had asthma on the application form, triggering a whole new list of questions that I had no idea how to answer as my condition is on a as-needed basis. Fuck Obamacare.

  • John||

    This is why good intentions produce so much evil. Good intentions prevent people from understanding that solving a problem can often be worse than the problem itself.

  • From the Tundra||

    You're right, of course. Retail health care is the answer, but for some reason, we can't get past the fucking insurance issue.

    Can you even imagine if car insurance operated the same way? I guarantee you an oil change wouldn't cost $40.

  • John||

    We can't past the insurance issue because insurance is the rational way that the market deals with a cost that is as uncertain as health care costs.

    Insurance is not the result of some government plot of mass hysteria. It is the result of the fact that no individual has any idea what their health care costs are going to be in the future. Next year your costs could be zero or they could be millions depending on how luck you are. So as a result, you can't rationally plan for health care because you don't know what costs to plan for. The solution is to purchase insurance that fixes your costs and thus allows you to eliminate your risk of financial ruin and give you a fix cost you can plan for.

    Anyone who thinks insurance is the problem doesn't understand markets.

  • Jordan||

    The vast majority of health care costs are neither unplanned nor catastrophic. What we have now is the equivalent of car insurance that pays for gas, oil changes, tire replacement, rims, and car stereos.

    Or imagine what grocery prices would be like if everyone had grocery insurance.

  • John||

    The problem is that the government mandates that every insurance policy cover everything. But that is the problem with the government not with insurance.

    But you also have to understand that people are risk adverse. They are always going to buy more insurance than they probably need. But that is their right.

    No question, the government needs to get the hell out of the insurance markets and let the insurance companies and the customers work out what is best. But some people on this board have this bizarre idea that medical insurance itself is the reason why health care costs are high.

  • Jordan||

    But some people on this board have this bizarre idea that medical insurance itself is the reason why health care costs are high.

    I've always gotten the impression that people here are just using it as shorthand for the third party payment system we have now.

  • John||

    The objection to third party payers is equally irrational. Insurance companies don't print their own money. They have just as much motivation as you or I not to pay too much money for a service. The best result for an insurance company is to charge the highest premium the customer will pay and pay out the lowest fee a doctor hospital will take. They have the same incentives an individual payer does.

    There are a lot of things driving costs. One of them is what BP mentions below. There are huge compliance costs to government mandates. The other thing no one talks about is the 1986 law that said hospitals couldn't turn anyone away. That law makes every hospital into a charity hospital. It used to be that if someone couldn't pay, they went to a charity hospital. So all of the cost of the poor an uninsured were absorbed by the charity hospitals. Now, they can go anywhere they want and the hospital eats the cost of treating them. That is then passed on to everyone. And since they can go anywhere they want and get free care, they go a lot more, especially to emergency rooms. And those costs, instead of being paid by charities are now paid by all of us in the form of higher medical costs.

  • Jordan||

    The consumer of the service is completely detached from the cost and has no incentive to shop around. The insurance company does not come in until the bill has already been submitted.

    Also, the costs of dealing with insurance companies are non-trivial.

  • Jordan||

    So, not only do consumers have every incentive to seek out the highest quality (usually correlated with price) care, but they have every incentive to consume far more care than they otherwise would.

  • Jordan||

    For example, my wife has people beg her for Advil prescriptions so that they don't have to pay $2 at Wal-Mart. And that's just the tip of the iceberg.

  • John||

    So, not only do consumers have every incentive to seek out the highest quality (usually correlated with price) care, but they have every incentive to consume far more care than they otherwise would.

    The insurance companies have the same incentive and more leverage to get it.

  • Jordan||

    And yet insurers are routinely overbilled, and overpay:

    The office has negotiated deals for services outside the office. By cutting out the middleman, Nunamaker said he can get a cholesterol test done for $3, versus the $90 the lab company he works with once billed to insurance carriers. An MRI can be had for $400, compared to a typical billed rate of $2,000 or more.

    If insurers had the leverage you think they have, they would also be paying the same rates the government does to providers.

    And doctor's and hospitals have to employ an army of people to deal with them.

  • John||

    You are giving me anecdotes. Consumers routinely overpay for everything. That is how the market works. It may be efficient in the macro, but it is never efficient in every single transaction.

    Sometimes insurance companies overpay. Well so does everyone else. Again, explain to me why insurance companies don't care about how much money they spend and thus are like no other human beings on earth?

  • John||

    The consumer of the service is completely detached from the cost and has no incentive to shop around.

    Bullshit. The insurance company determines which doctors it will deal with. If doctor charges too much, the insurance company can strike that doctor off the list of covered providers. You can't go to any doctor with your insurance. You can go to the doctors that your insurance company says they will pay for.

    Moreover, insurance companies have more power to control prices. You are one purchase. An insurance company represent hundreds or even thousands of purchases to a doctor and thus has a hell of a lot more leverage in getting that doctor to set his fees lower.

    Why do you guys forget everything you know about markets and incentives on this topic?

  • Plopper||

    How is it irrational to think that an insurance oligopoly would rather raise premiums than spend the effort to try to reduce costs?

    If they had real competition it wouldn't be so much an issue, but they don't.

  • Jordan||

    And high deductible catastrophic insurance is illegal.

  • John||

    And high deductible catastrophic insurance is illegal.

    For that to be true, insurance companies have to be less sensitive to costs with their money than you are with yours. Why is that the case? Why are insurance companies totally irrational and seem to take not interest in limiting their costs?

    It is like a religion with you people. For some reason medical insurance companies must act totally irrationally and against their interests.

  • Jordan||

    For that to be true, insurance companies have to be less sensitive to costs with their money than you are with yours.

    What? The government passes laws, not insurance companies.

  • John||

    But for the lack of catastrophic policies to be driving costs, you have to assume that insurance companies are willing to pay higher costs than you are. And that assumes they are irrational.

  • Jordan||

    you have to assume that insurance companies are willing to pay higher costs than you are.

    No, you don't. You have to remember supply and demand. If something is "free" to me, I'm going to consume a lot more of it.

  • John||

    No, you don't. You have to remember supply and demand. If something is "free" to me, I'm going to consume a lot more of it.

    But it isn't free to the insurance company and you won't be getting it unless they agree to pay for it. Why do you think insurance companies give their customers any service they want, as much as they want, at any price? That is not how it works.

  • Jordan||

    See my response above. Also, there was an article I can't find now where a doctor was billing insurers $100 for IVs, but when he switched to cash-only, he stopped charging for them altogether because they were so cheap. Neither he, nor the patient, nor the insurer had any idea of the true cost.

  • Juice||

    And high deductible catastrophic insurance is illegal.

    That's what I have right now.

  • BakedPenguin||

    Additionally, there are now an army or "health-care" workers who do nothing related to health care. Medicare & Medicaid coders and administrators all need salaries, but provide absolutely zero health care benefit. This is a massive part of health care costs, yet it goes discussed.

  • BakedPenguin||

    "...yet it is not discussed."

  • From the Tundra||

    Perhaps not the whole problem, but certainly a big contributor. I can see hedging uncertainty with catastrophic insurance, but I don't see the benefits in what insurance has morphed into.

    As someone who hasn't had employer provided insurance since the 90s, I've tried a variety of different approaches to the question of uncertainty. A combination of catastrophic insurance (for the "millions" you referenced) and accommodating providers (cash discounts, etc.) seems to work pretty well. It does require a person to plan, however.

    I realize that insurance is not a government plot. It is, however, a layer of shit that further isolates consumers from costs and realities.

  • John||

    It only isolates consumers from costs if y ou assume that insurance companies have no interest in limiting their costs and don't care what they pay and are thus like no other business on earth.

  • From the Tundra||

    OK. I agree with you John. My initial comment was sloppy. The insurance companies are not the problem. Insurance in other realms works beautifully (and has less government interference).

    Fewer and fewer good options for arrangements directly between providers and consumers is the problem.

    I like retail options. A price list on the wall. Unfortunately, with the exception of LASIK, plastic surgery and walk in clinics, we're going the other way.

  • John||

    We need to get the government out of the insurance markets, we need to stop mandating that hospitals treat free of charge anyone who shows up, we need to transform medicaid and medicare into a voucher program so the government doesn't force medical providers to spend billions complying with regulations, and we need to cut the medical guild down to size and let pharmacists and nurses and PAs start giving a lot more routine care and such.

    Those things alone would do wonders for the problem.

  • VG Zaytsev||

    I realize that insurance is not a government plot.

    The prepaid health coverage that we call insurance came about by a series of government plots.

    1) Wage controls during WWII were circumvented by employers offering health insurance.

    2) The practice was incentivized after the wage controls were lifted via preferential tax treatment; by the Truman administration as a stepping stone to socialized medicine.

    3) Further legal changes made during the Nixon administration incentivized employer provided insurance to move from a major medical model to first dollar coverage via HMOs.

    4) The creation of Medicare made the federal government the dominant factor in health care.

  • ||

    Damn, that's an expensive oil change.

  • ||

    Dr. Singer is obviously a horrible person who hates the poor, children, and elderly and wishes them all to die without the government provided healthcare that is everyone's right.

  • Hopfiend||

    truth

    /sarc

  • ||

    I have yet to have a single person explain to me how medical care is a right. When I ask " How can you believe that another person's labor and expertise are your right? You would compel them to work if they chose not to?"

    They like the way it sounds and feels when they say medical care is a right, but when you start talking about the details of what that means suddenly they are out of time and have somewhere else to be.

  • Palin's Buttplug||

    Medical care is not a right, of course. But it could be in the future. A "right" is something the government bestows on you via social contract.

    Rights are legal, social, or ethical principles of freedom or entitlement; that is, rights are the fundamental normative rules about what is allowed of people or owed to people, according to some legal system, social convention, or ethical theory.[1] Rights are of essential importance in such disciplines as law and ethics, especially theories of justice and deontology.

    Wikipedia

  • John||

    http://www.youtube.com/watch?v=GuGtxt84wPQ

    BUSHPIG!!!! CHRISTFAGS!!!

    Just let it out shreek. If all you can do is scream and throw shit, there is no point in fighting it. Just let it out and eventually you will exhaust yourself and it will pass.

  • Concerned Citizen||

    I am endowed with rights by my Creator. They are inalienable, meaning I can't lose them.
    Now go suck a diseased Statist's cock and die.

  • Palin's Buttplug||

    Please provide a comprehensive list of these rights. We may put them into law if they are good enough.

  • Concerned Citizen||

    Life, liberty, pursuit of happiness, pretty much anything I want to do as long as I don't infringe on the rights of others.
    How'd that cock taste?

  • Palin's Buttplug||

    Not comprehensive nor even real. My Creator says I have the right to snort coke off the backside of an 18-yr old hottie that I pay $200 for her services.

    But that right has been denied to me.

  • Jordan||

    And yet you still have that right.

  • Jordan||

    Stalin's Buttboy = Tony?

  • GPZsug||

    They're both moral nihilists. Which is fine. But they like to use that flimsy Wikipedia definition of rights he quoted above to win semantic arguments. And then all of the minarchists here (who don't have a much more concrete definition of rights) overlook the semantics and start yelling.

  • Concerned Citizen||

    WTF?

  • GPZsug||

    "WTF?"

    Concerned Citizen:
    "Life, liberty, pursuit of happiness, pretty much anything I want to do as long as I don't infringe on the rights of others."

    That's nice and all, but what does having a right to liberty or the pursuit of happiness mean? It's not much better than PB's definition.

    The last part: "as long as I don't infringe on the rights of others" is good because it implies that real rights are negative rights.

    Don't get me wrong. I'd much rather live in your world than his, but I wish your concept of rights was more precise.

  • R C Dean||

    You think "whatever the government bestows" gives you precision?

  • GPZsug||

    You think "whatever the government bestows" gives you precision?

    I think you're mistaking my argument as an agreement with PB. Whatever the government bestows IS whatever the government bestows. And the government tends to bestow what the majority wants. That's the extent of his philosophy. The first part is a tautology. The second is empirically true.

    But he often uses the term "right" in reference to the things that government bestows. It's a completely different definition from that used by everyone who argues with him, and no one ever points that out. They just get mad.

    On the few occasions where someone attempts to define their version of rights it's usually a very mushy definition like the one Concerned Citizen gave.

  • ||

    How would you define rights?

  • Concerned Citizen||

    You're calling Tom Jefferson's definition mushy?

  • GPZsug||

    How would you define rights?

    As the set of all acts of free will that can be exercised simultaneously (i.e. that aren't conflicting). Given that all acts of free will involve the physical world, ownership (private property) satisfies that definition.

  • everyone||

    Shrike is right with the rights. The government is right, therefore its rights are right.


    Palin's Buttplug| 9.2.13 @ 5:57PM |#

    If everyone agreed with me I would quit posting.
  • ||

    You are a fucking moron.

  • ||

    I was being sarcastic as obviously, to anyone with half a brain at least, you cannot possibly claim a right to something that requires someone else provide you goods and/or services.

  • Invisible Finger||

    Self-medication should be a right.

    Sadly, that is the only medical care the majority of people are AGAINST.

  • Palin's Buttplug||

    (Reuters) - France, which backs military action to punish Syria for a deadly chemical weapons attack, tried to rally support from its European Union partners on Friday but met scepticism from governments wary of turning their backs on the United Nations.

    The French are officially now more macho than the GOP.

  • John||

    http://www.youtube.com/watch?v=GuGtxt84wPQ

    BUSHPIGS!!!

    Apparently you took your meds just long enough to convince the judge not to send you back to the hospital and let out back out on the streets.

  • ||

    Macho counts for two things. The first one is jack, and I bet you can guess what the second one is.

  • Mike M.||

    Weigel is now calling people out for lack of machismo? Just hilarious. Pee Wee Herman is more macho than this motherfucker.

  • everyone||

    I believe Shrike is saying the French are Macho Men.


    Palin's Buttplug| 9.2.13 @ 5:57PM |#

    If everyone agreed with me I would quit posting.
  • Acosmist||

    Machismo? So now you hate women?

  • Jake W||

    The French are now officially war-happy socialists.

  • GPZsug||

    Doctors are being reduced to shift workers who are compelled to follow guidelines and protocols that tell them how to practice and they spend a great amount of time entering data into computers.

    There are plenty of reasons to oppose government intervention in medicine, but this isn't one of them. Most medical care doesn't require more than following guidelines and protocols. The problem is that people think the law should prevent anyone but a doctor from doing them. A high school dropout could be taught to measure blood pressure. Midas doesn't employ anyone with a PhD in thermodynamics to service air conditioners.

  • R C Dean||

    Bingo. There is zero dispute, due to the mountains of evidence, that best practices, which require standardization and thus protocols, algorithms, etc., results in better outcomes.

    This, of course, is true regardless of whether the govt is involved at all.

  • GPZsug||

    I can understand where people are coming from when they want a doctor to do everything. Doctors will catch some things that a less trained practitioner won't. But the likelihood of such a situation is tiny, and restricting care to conditions that could be perfect ends up eliminating a lot of care that could be good.

  • PH2050||

    Can the medical AIs and hot robot nurses get here faster please?

  • RBS||

    So, when is reason going to give us the weekend sports thread? Anyway, Gamecock fans: Clowney is awesome but seriously, stop talking about his hit in the bowl game against Michigan like it changed they way the universe works or something. It was a big hit, in a meaningless game.

  • John||

    He wasn't so awesome last week. He look fat and out of shape. If he won't get in shape when he is playing for a draft position that will make him millions, why will he get in shape after he makes those millions?

  • RBS||

    Well, the story out of Columbia was that he had some sort of "stomach bug"... Yeah, I think his work ethic is a legitimate question when it comes to the NFL. I mean, he's been a monster at every level he's played at and hasn't really faced any adversity football wise so he hasn't really had any need to really develop technically. I don't think you can get away with being on cruise control in the NFL, there are tons of guys with all the physical gifts in the world who got spit out the bottom of the NFL because they never figured out how to work hard.

  • Concerned Citizen||

    I blame their lack of fathers.

  • John||

    The problem with someone like Clowney who is able to just destroy people with his athletic ability is that they never learn how to work hard and never learn proper technique. I don't care what kind of freak you are, you can't athlete your way to being a top NFL player. Everyone is a freak in the NFL. So to be good you have to work hard and have great technique. The league is littered with athletic freaks that GMs fell in love with at the combine who never amounted to anything because they didn't know how to play football and were too lazy or stupid to learn.

  • RBS||

    Well yeah, think about the best O-Line in college football and one, maybe two of those guys will ever play a single down in the NFL

  • Palin's Buttplug||

    Well, I went to UGA and our pass protection did not impress vs Clemson. Clowney may have a career day today I am afraid to say.

  • RBS||

    I hope yall bounce back today. The morons in Columbia are becoming unbearable.

  • everyone||

    You tell 'em, bulldog.


    Palin's Buttplug| 9.2.13 @ 5:57PM |#

    If everyone agreed with me I would quit posting.
  • The Late P Brooks||

    With me here the never-ending circle jerk is broken and the chance a good discussion ensues is enhanced.

    And they told me comedy is dead.

  • John||

    http://thehill.com/blogs/globa.....resolution

    Reid facing double digit Democratic defections on the Syria resolution.

  • The Late P Brooks||

    There is zero dispute, due to the mountains of evidence, that best practices, which require standardization and thus protocols, algorithms, etc., results in better outcomes.

    But what about empathy? And inspired guesses?

    It works on the teevee.

  • Ashlyn||

    Best practices include playing broody piano in your office, manipulating and harassing your co-workers, and suddenly fleeing rooms after your latest Eureka! moment.

    Keep up.

  • xteeth||

    Sadly for you though according to Forbes magazine, which is rather conservative, more and more doctors are accepting Medicare patients. Both Rand and Ron Paul had practices that were half of more government funded patients. Looks to me like you lose this one. Look at your heroine Ayn Rand. She died alone, broke, on Medicare and Social Security. After spending a lifetime spitting on those things. Grow up. Understand that we are all related and interdependent.

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