The doctor is not in.

The United States already faces a growing physician shortage. As our population ages, we require more and more intensive health care. At the same time, enrollment in medical schools has been essentially flat, meaning we are not producing new physicians at anywhere near the rate we need to. In fact, according to the American Association of Medical Colleges, we face a shortfall of more than 150,000 doctors over the next 15 years.

And it could get a whole lot worse.
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Existing government programs already reimburse physicians at rates that are often less than the actual cost of treating a patient. Estimates suggest that on average physicians are reimbursed at roughly 78% of costs under Medicare, and just 70% of costs under Medicaid. Physicians must either make up for this shortfall by shifting costs to those patients with insurance -- meaning those of us with insurance pay more -- or treat patients at a loss.

As a result, more and more physicians are choosing to opt-out of the system altogether. Roughly 13% of physicians will not accept Medicare patients today. Another 17% limit the number of Medicare patients they will see, a figure that rises to 31% among primary care physicians. The story is even worse in Medicaid, where as many as a third of doctors will not participate in the program.

The number of waivers the Obama administration has awarded for a provision of the year-old healthcare reform law grew by 128 in March.

With the new waivers, that means 1,168 businesses, insurers, unions and other organizations have received one-year exemptions from a healthcare reform provision requiring at least $750,000 in annual benefits.
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The new numbers were posted on an HHS website Friday night without an announcement from the department. The 128 waivers added in March track closely to the 126 HHS awarded in February.

The number of people covered by waivers grew about 300,000 over the past month to 2.93 million. HHS says the waivers represent less than 2 percent of the private insurance market.

"I hope to be able to get waivers from Congress and the white house to allow us to do so. At the end of the day, if you are going to provide health care to all of our people in a cost effective way, you have to get rid of the health insurance companies, not profiteering and bureaucracy," Sen. Bernie Sanders (I-VT) told MSNBC.

Visit msnbc.com for breaking news, world news, and news about the economy

It could even be that no such piece of major legislation has created the continued, vehement public opposition that health care has provoked since the Kansas-Nebraska Act of 1854 -- which resulted in the abrogation of the Missouri Compromise.
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The opposition to health care turned an election already going south into a political catastrophe. Election studies at Stanford University and the University of Minnesota concluded that at least one-third of the House seats that Democrats lost can be attributed to the electorate?s negative reaction to the health care bill. Election night exit polls found that a near majority (48 percent) of voters favored outright repeal. Independents who favored outright repeal voted for Republicans, 86 percent to 9 percent.

There is one big underlying factor that continues to cause many Americans to oppose the health care bill: Its passage was anti-democratic. If the Republicans' campaign slogan of 1854 was the "Crime Against Kansas," in 2010 it would be the "Crime Against Democracy."

Deals to buy votes in the House and Senate, including extra funding for state projects, all became part of the 2,000-page bill that most representatives never read. These deals deeply affected the American people, making them feel the law was forced on them, despite their opposition.

This fundamental perception of contempt for the American people?s will has sustained the opposition. It is likely to do so until the bill's anti-democratic stain is expunged.

You may recall that there were 222 such waivers approved in November. That number has now jumped to 729 through the end of December. The total number of people covered by the waivers has gone from 1.5M to just under 2.2M. The list includes the usual assortment of union locals and businesses.

A Senate vote to repeal [the Dems' recent health-care legislation] probably would fail. Even if it passed, President Barack Obama would veto it. So then... why not vote?

A couple of weeks ago, a National Public Radio anchor asked Reid: "If you have the votes, why not let it come to a vote?"

Reid's answer: "Because I think it's important that people understand that we do not think we got perfection with this legislation. We want to try to improve it. We don't want to try to destroy it."

Translation: Election? What election?

Allowing a repeal vote would let citizens -- many of whom abhor this exorbitantly expensive health care entitlement -- to see who in Washington follows their wishes. And who doesn't.

Reid's blockade invites voters to tap Democrats on the shoulder even more forcefully in 2012. That's why we have elections. To send politicians to Washington to do what constituents demand.

No, we don't favor a complete repeal of the law. We've said repeatedly that we'd rather see a scaled-down, market-driven law that still provides expanded access to health care.

But first things first: Reid ignored public opinion in the rush to pass this massive expansion. Now he's repeating the same grievous mistake.

Come on, Sen. Reid. Call the vote. What are you afraid of?

Federal finances are buckling under the weight of unaffordable entitlement programs. So what is the primary aim of the [ObamaCare]? Open-ended entitlement expansion: to more people at greater expense than anytime since the 1960's. If CBO is right, 32 million people will be added to the health entitlement rolls, at a cost of $938 billion through 2019, and growing faster than the economy or revenues thereafter.

How, then, does the ACA magically convert $1 trillion in new spending into painless deficit reduction? It's all about budget gimmicks, deceptive accounting, and implausible assumptions used to create the false impression of fiscal discipline.

Sometimes criticism comes in the unlikeliest of places.

On Friday's "Inside Washington," Newsweek columnist Evan Thomas, once an editor at the magazine with a long track record of having liberal positions (even once having likened President Barack Obama to a deity), noted the modest improvement in the unemployment number reported on Friday. However, nearly a year after Obamacare was passed and signed into law, he admitted Republicans were right for voicing their opposition of it.

"It ain't because of Congress," Thomas said. "The unemployment will go down a little bit but the game in Washington will still be this unreal game. Health care though -- I got to say, is one place where I think where Republicans are right."
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"The health care bill is a disaster," Thomas continued. "We?re sort of slowly learning -- it's not working. It's interesting -- they're implementing it and it's not working out at all as people anticipated. There's all sorts of wildly wrong projections. As it's being practiced -- it's failed."

To interested Hill staff:

CBO and the staff of the Joint Committee on Taxation (JCT) have not yet developed a detailed estimate of the budgetary impact of H.R. 2, the Repealing the Job-Killing Health Care Law Act, which would repeal the major health care legislation enacted in March 2010. Yesterday, we released a preliminary analysis of that legislation indicating that, over the 2012-2021 period, the effect of enacting H.R. 2 on the federal budget as a result of changes in direct spending and revenues is likely to be an increase in deficits in the vicinity of $230 billion, plus or minus the effects of forthcoming technical and economic changes to CBO's and JCT's projections for that period.

We have been asked to provide the revenue and direct spending components of that total. Extrapolating the estimated budgetary effects of the original health care legislation and accounting for the effects of subsequent legislation, CBO anticipates that enacting H.R. 2 would probably yield, for the 2012-2021 period, a reduction in revenues in the neighborhood of $770 billion and a reduction in outlays in the vicinity of $540 billion, plus or minus the effects of forthcoming technical and economic changes to CBO's and JCT's projections.

CBO will post a Director's blog with this information on the CBO website shortly. Please let me know if you have any questions.


Sandy