Mene, Mene, Tekel Upharsin
For the benefit of any readers who missed some education in Christian doctrine while growing up, these words are from the Old Testament Book of Daniel (5:25-29). The passage reads: “And this is the writing that was written, MENE, MENE, TEKEL, UPHARSIN. 26 Thisis the interpretation of the thing: MENE; God hath numbered thy kingdom, and finished it. 27 TEKEL; Thou art weighed in the balances, and art found wanting. 28 PERES; Thy kingdom is divided, and given to the Medes and Persians.
In current idiom among the literate, just referring to Mene, Mene is taken to mean “the handwriting is on the wall,” and something very bad is coming. In the context of this blog post, the something bad, Obamacare, is already here, even though the full implications will not be realized for several years. However, the coming events are easily predictable simply by looking at the U.K National Health Service (NHS), the role model for the future of socialized medicine in the United States.
What makes this Biblical prophecy particularly interesting in the context of Obamacare is the connection with money. Various scholars agree the words correspond to Aramaic names of currency measures: mina (“to count”), tekel (alternative for shekel; from “to weigh”) and upharsin (or peres, half of a mina, from the root “to divide.” The upharsin also resembled the word for Persia. Corresponding verb forms were “measured, weighed, divided.” Wikipedia has a good summary of the concept and various Christian and Jewish website found by a browser search will expand on multiple discussions of mene, mene tekel upharsin.
How does the British medical situation predict coming dangers in hospital and direct patient care services in the United States? The predicaments of the NHS suggest an inevitable result in this country by the enormous taxpayer-funded expansion of coverage in the 2,000+ page original Obamacare bill and the so far astronomical growth of connected regulations. By one count these amount to “1,147,271 words of Obamacare regulations published so far—270% as long as the text of the statute.” One easily foreseen problem in the U.S. is the coming shortfall of doctors to provide all these wonderful new services and the most likely solution that will be sought—a growth in reliance on foreign-trained physicians and the consequent relaxation of accreditation requirements. Here is what is happening in the NHS now from a recent story in the U.K. Telegraph.
Sarah Knapton, Science Correspondent for the Telegraph on 18 Apr 2014 wrote: “Half of all foreign doctors in Britain do not have the necessary skills to work here but can practise because the competency exam is too easy, a major study finds. The majority of the 88,000 foreign doctors in the health service would fail exams if they were held to the same standard as their British colleagues, according to the research.” Of note is that the current passing level required for the exams is 63 percent. Does it not seem a bit worrisome to think you may visit a doctor who got only a fraction over six out of ten questions on a competency exam correct?
The article goes on to report that these foreign educated physicians “make up almost a third of all NHS doctors but account for approximately two thirds of those struck off each year.” “Struck off” the medical register is the British equivalent of a U.S. physician having their license revoked. Without going into extensive research on the comparative difficulty of revoking a physician’s license in the U.K. versus the U.S., multiple anecdotal sources at least intuitively suggest that in neither country is this something easily done.
What is the comparable situation in the United States? Currently it is very difficult for a foreign-trained physician to get a license—requiring as long as ten years. Various studies estimate that while there are close to 800,000 practicing doctors in this country, by 2020 there will be a shortfall of 150,000 or more. Of the existing U.S. doctor pool, estimates suggest a bit under 200,000 are foreign trained.
It does not take the iconic rocket scientist to figure out a likely solution to the physician shortage. Already there are calls to simply lower the U.S. standards required to practice medicine, admittedly unmatched anywhere else in the world. There are many thousands of foreign educated doctors already in this country who are driving cabs or working in low-level healthy related fields while either waiting through the long licensing process or have simply given up. Calls for streamlining the process appear regularly. Nyapati Raghu Rao, an Indian-born psychiatrist and past chairman of the American Medical Association’s International Medical Graduates Governing Council was quoted in a NewYork Times August 2013 story saying, “It is doubtful that the U.S. can respond to the massive shortages without the participation of international medical graduates. But we’re basically ignoring them in this discussion and I don’t know why that is.” Another comment in this story was, “Immigrant advocates and some economists point out that the medical labor force could grow much faster if the country tapped the underused skills of the foreign-trained physicians who are already here but are not allowed to practice.”
If the U.S. follows the course of the NHS as seems likely, then I wish someone in our government would put to the British people a telling question from the 2nd longest-running TV courtroom series in history, the People’s Court, presided over for the last 13 years by retired Florida State Circuit Court Judge MarilynMilian. Millan often asks defendants or plaintiffs with ridiculous stories, “And how did that work out for you?”