18 minutes ago, toolg said:

How can you say it is not a factor? Dobbs already happened. The situation got worse. OB services will continue to decline. This is not occurring in a vacuum. If you had said a tanker truck exploded in the Hedrick maternity ward, then that would be an extenuating circumstance. 

Because the OB at Hedrick did not leave the St Luke's health system, let alone the state.   Once again, this same exact thing happened to St Luke's health system in 2016 with Wright Memorial closing its maternity unit and shifting patients to Hedrick medical center.   So what, that time it wasn't because of Roe v Wade but this time it is?  Sounds like single variable analysis to me.....

How about all the maternity wards in Philly that closed over the years that I cited?   How about the two that closed in Wyoming County, New York this year.  New York, a state that codified abortion rights into state law. 

Basically what you're doing is saying that when a maternity ward closes in a state with restrictive abortion laws, Dobbs played a factor.  But when it happens in a state without stringent abortion laws, oh well that's different. We'll just ignore the externalities that are present there as it would invalidate the single variable analysis of blaming Dobbs....

43 minutes ago, BBE said:

And yet no one mentions that the single highest cost to OB-GYNs is malpractice insurance and the rate they are sued.  This trend goes back nearly 20 years.

 

And the general trend of young doctors choosing more lucrative specialties. 

This is true. And it is only getting worse.

2 minutes ago, Phillyterp85 said:

Because the OB at Hedrick did not leave the St Luke's health system, let alone the state.   Once again, this same exact thing happened to St Luke's health system in 2016 with Wright Memorial closing its maternity unit and shifting patients to Hedrick medical center.   So what, that time it wasn't because of Roe v Wade but this time it is?  Sounds like single variable analysis to me.....

How about all the maternity wards in Philly that closed over the years that I cited?   How about the two that closed in Wyoming County, New York this year.  New York, a state that codified abortion rights into state law. 

Basically what you're doing is saying that when a maternity ward closes in a state with restrictive abortion laws, Dobbs played a factor.  But when it happens in a state without stringent abortion laws, oh well we'll just ignore the externalities that are present there as it would invalidate the single variable analysis of blaming Dobbs....

Dobbs has had an effect and will continue to have an effect on the profession as a whole. Even in states where abortion laws are less restrictive. Are there other factors? Yes, there are.

3 minutes ago, toolg said:

Dobbs has had an effect and will continue to have an effect on the profession as a whole. Even in states where abortion laws are less restrictive. Are there other factors? Yes, there are.

I see.  So even in a state that codified abortion rights into law, which makes the Dobbs decision irrelevant to the current status of maternity services as again, the state codified abortion rights into law, it’s actually still the Dobbs decision playing a factor when a maternity unit closes in that state.

This is doubly interesting given that part of the theory is that OBs are leaving red states to go work in blue states with abortion rights as a result of Dobbs.  and yet when a maternity unit closes in New York, it’s also still apparently related to Dobbs.

I mean come on….

10 minutes ago, Phillyterp85 said:

I see.  So even in a state that codified abortion rights into law, which makes the Dobbs decision irrelevant to the current status of maternity services as again, the state codified abortion rights into law, it’s actually still the Dobbs decision playing a factor when a maternity unit closes in that state.

This is doubly interesting given that part of the theory is that OBs are leaving red states to go work in blue states with abortion rights as a result of Dobbs.  and yet when a maternity unit closes in New York, it’s also still apparently related to Dobbs.

I mean come on….

I got stats. LINK

Quote

• Nationally, one in five office-based OBGYNs (20%) report they have personally felt constraints on their ability to provide care for miscarriages and other pregnancy-related medical emergencies since the Dobbs decision. In states where abortion is banned, this share rises to four in ten OBGYNs (40%).
• Four in ten OBGYNs nationally (44%), and six in ten practicing in states where abortion is banned or where there are gestational limits, say their decision-making autonomy has become worse since the Dobbs ruling. Over a third of OBGYNs nationally (36%), and half practicing in states where abortion is banned (55%) or where there are gestational limits (47%), say their ability to practice within the standard of care has become worse.
• Most OBGYNs (68%) say the ruling has worsened their ability to manage pregnancy-related emergencies. Large shares also believe that the Dobbs decision has worsened pregnancy-related mortality (64%), racial and ethnic inequities in maternal health (70%) and the ability to attract new OBGYNs to the field (55%).

 

12 minutes ago, toolg said:

I got stats. LINK

 

Those stats do nothing to support your claim that the Hedrick maternity unit closing was related to Dobbs….

And once again, you are conflating a general trend with a specific example.

8 minutes ago, Phillyterp85 said:

Those stats do nothing to support your claim that the Hedrick maternity unit closing was related to Dobbs….

And once again, you are conflating a general trend with a specific example.

What else can I say? The example fits the trend.

38 minutes ago, toolg said:

I got stats. LINK

 

Why would they say 1 in 5 at 20%, then 4 in 10 at 40% instead of saying 2 in 5?

28 minutes ago, toolg said:

What else can I say? The example fits the trend.

Except for the fact that if you actually examine what happened with this medical center, it doesn't. Once again, blaming Dobbs every time a maternity unit closes down actually hurts your argument and will lessen your credibility when you later try to show an example of a maternity unit that closes down that's actually related to the Dobbs decision (such as the case of a maternity unit closing down because their OBs leave the state to go practice in a state with a more friendly environment). 

I'll give you an example.  In the late 90s, early 2000s, my father and several of his colleagues stopped practicing medicine in the state of PA.  The driving factor for them was the rising malpractice insurance costs. And so they left PA for other states with lower malpractice premiums.  

It would be silly to then point to an example of a couple physicians leaving one PA hospital for another PA hospital, and then blame the high PA malpractice insurance premiums for that hospital losing physicians.  

19 minutes ago, Phillyterp85 said:

Except for the fact that if you actually examine what happened with this medical center, it doesn't. Once again, blaming Dobbs every time a maternity unit closes down actually hurts your argument and will lessen your credibility when you later try to show an example of a maternity unit that closes down that's actually related to the Dobbs decision (such as the case of a maternity unit closing down because their OBs leave the state to go practice in a state with a more friendly environment). 

I'll give you an example.  In the late 90s, early 2000s, my father and several of his colleagues stopped practicing medicine in the state of PA.  The driving factor for them was the rising malpractice insurance costs. And so they left PA for other states with lower malpractice premiums.  

It would be silly to then point to an example of a couple physicians leaving one PA hospital for another PA hospital, and then blame the high PA malpractice insurance premiums for that hospital losing physicians.  

Dobbs did not only effect Missouri. It effects all of the United States. It's not the same situation as your father opening a new practice in a different state. The consequences are nationwide. Yes, it will be more severe in states whose laws are more restrictive. But the effects will be felt everywhere.

 

44 minutes ago, RPeeteRules said:

Why would they say 1 in 5 at 20%, then 4 in 10 at 40% instead of saying 2 in 5?

4 in 10 or 2 in 5... It's the same thing.

15 minutes ago, toolg said:

Dobbs did not only effect Missouri. It effects all of the United States. It's not the same situation as your father opening a new practice in a different state. The consequences are nationwide. Yes, it will be more severe in states whose laws are more restrictive. But the effects will be felt everywhere.

Not really.  The Dobbs decision returned the decision on abortion law back to the states.  For states that either codified abortion into the legislature or simply didn't change any abortion restrictions, nothing changed.  And if anything, those states should be seeing an increase in OBs coming to them from other states that did enact strict abortion restrictions.

Now, could it have an affect nationwide say 10+ years down the road?  Sure.  An argument can be made that in those states that enacted those strict abortion restrictions, it will result in fewer students in those states wanting to go into med school to become OBs, which will result in an overall lower number of projected OBs nationwide.   But that's down the road, and has nothing to do with the current conversation which all started with this misinformation of a tweet.   

14 minutes ago, Phillyterp85 said:

Not really.  The Dobbs decision returned the decision on abortion law back to the states.  For states that either codified abortion into the legislature or simply didn't change any abortion restrictions, nothing changed.  And if anything, those states should be seeing an increase in OBs coming to them from other states that did enact strict abortion restrictions.

Now, could it have an affect nationwide say 10+ years down the road?  Sure.  An argument can be made that in those states that enacted those strict abortion restrictions, it will result in fewer students in those states wanting to go into med school to become OBs, which will result in an overall lower number of projected OBs nationwide.   But that's down the road, and has nothing to do with the current conversation which all started with this misinformation of a tweet.   

I can see where the tweet was misconstrued... They are still delivering babies in MO, except for the fact the women of Chillicothe have to travel 90 minutes further to find a maternity ward.

13 minutes ago, toolg said:

I can see where the tweet was misconstrued... They are still delivering babies in MO, except for the fact the women of Chillicothe have to travel 90 minutes further to find a maternity ward.

She’s blaming the Dobbs decision for the center closing its maternity ward, saying it’s because the MO laws now can penalize doctors for procedures they may have to perform on a pregnant woman and implying that it’s causing the OBs to leave and go practice in states that don’t have these laws.  
And that would be all well and good if that’s what actually happened here, which as we’ve gone over already, isn’t what happened.  The OB isn’t even leaving the St Luke’s health system.  So her tweet saying it’s because doctors can now face penalties there as the cause for this happening makes absolutely no sense as the OB there is still practicing in Missouri.

2 minutes ago, Phillyterp85 said:

She’s blaming the Dobbs decision for the center closing its maternity ward, saying it’s because the MO laws now can penalize doctors for procedures they may have to perform on a pregnant woman and implying that it’s causing the OBs to leave and go practice in states that don’t have these laws.  
And that would be all well and good if that’s what actually happened here, which as we’ve gone over already, isn’t what happened.  The OB isn’t even leaving the St Luke’s health system.  So her tweet saying it’s because doctors can now face penalties there as the cause for this happening makes absolutely no sense as the OB there is still practicing in Missouri.

You are taking Piper's tweet literally, where I am commenting on the fact hospitals are truncating OB services.

2 minutes ago, toolg said:

You are taking Piper's tweet literally, where I am commenting on the fact hospitals are truncating OB services.

Which has very little to do with Dobbs.

Just now, BBE said:

Which has very little to do with Dobbs.

I disagree. There are other factors at play too but I think Dobbs has had an effect.

Just now, toolg said:

I disagree. There are other factors at play too but I think Dobbs has had an effect.

Very little effect.  Just drop the confirmation bias.  What shutdown was a maternity ward which has the exact opposite function of abortion. 

 

 

6 minutes ago, toolg said:

You are taking Piper's tweet literally, where I am commenting on the fact hospitals are truncating OB services.

How else am I supposed to take her tweet? She made a claim, her claim is false. That’s what I’ve been commenting on this whole time.

The biggest factor is that smaller, regional hospitals are losing money hand over fist due to the shift in payor mix. I've looked at a bunch of these as they go through bankruptcy -- the issue is the expansion of Medicaid that started with the passage of Obamacare. The easiest way to think about it is this -- hospitals lose money on every Medicaid patient, so they have to make enough on others (Medicare, private insurance) to offset the losses on Medicaid patients. But as the overall number of Medicaid patients has increased, especially in rural and lower income urban markets, the mix has gotten out of whack and there have been a ton of bankruptcies in the hospital space. If you live in Philly, this is what put Hahnemann out of business -- all the profitable patients went to Jefferson and UPenn, and Hahnemann was getting way too many Medicaid patients. 

So the answer to survive is to cut costs or become a "critical access hospital" (designated by government, basically guarantees profit for serving a rural community that is underserved). As @BBE pointed out, costs are also high in OB-GYN due to insurance premiums and lack of doctors. So they are all consolidating those operations in order to cut costs and dedicate space to more profitable disciplines. Dobbs will have an impact in states that pass restrictive laws with higher premiums and fewer docs, thereby exacerbating the cost problem. But the primary issue is Medicaid is bankrupting hospitals.

10 minutes ago, BBE said:

Very little effect.  Just drop the confirmation bias.  What shutdown was a maternity ward which has the exact opposite function of abortion. 

The point I am trying to make is Dobbs is going to have an effect on other OB-GYN services. If you don't want to believe it, fine. Let's wait and watch for things to get even worse.

Just now, toolg said:

The point I am trying to make is Dobbs is going to have an effect on other OB-GYN services. If you don't want to believe it, fine. Let's wait and watch for things to get even worse.

Dobbs will have an effect on abortion services.   That is it.  You posted a ridiculous overreaction tweet, dug your heels in, and are making a claim that the Dobbs decision will have a measurable effect on a trend that has twenty plus years of momentum.   

 

I'm sorry if I find your posts unconvincing and nothing more than partisan pearl clutching.

12 minutes ago, vikas83 said:

The biggest factor is that smaller, regional hospitals are losing money hand over fist due to the shift in payor mix. I've looked at a bunch of these as they go through bankruptcy -- the issue is the expansion of Medicaid that started with the passage of Obamacare. The easiest way to think about it is this -- hospitals lose money on every Medicaid patient, so they have to make enough on others (Medicare, private insurance) to offset the losses on Medicaid patients. But as the overall number of Medicaid patients has increased, especially in rural and lower income urban markets, the mix has gotten out of whack and there have been a ton of bankruptcies in the hospital space. If you live in Philly, this is what put Hahnemann out of business -- all the profitable patients went to Jefferson and UPenn, and Hahnemann was getting way too many Medicaid patients. 

So the answer to survive is to cut costs or become a "critical access hospital" (designated by government, basically guarantees profit for serving a rural community that is underserved). As @BBE pointed out, costs are also high in OB-GYN due to insurance premiums and lack of doctors. So they are all consolidating those operations in order to cut costs and dedicate space to more profitable disciplines. Dobbs will have an impact in states that pass restrictive laws with higher premiums and fewer docs, thereby exacerbating the cost problem. But the primary issue is Medicaid is bankrupting hospitals.

Wait.  Let me rush to Twitter and post "Obama care is killing health-care and people because they no longer have access to hospitals "...

29 minutes ago, BBE said:

Very little effect.  Just drop the confirmation bias.  What shutdown was a maternity ward which has the exact opposite function of abortion. 

 

 

The issue isn’t abortion.  The issue is the new laws that restrict a physician’s autonomy in the case of an emergency and the onus they put on the physician to prove that an abortion didn’t happen in the event that a miscarriage occurs.  It just adds much difficulty to the job and decreases incentive to go into the field (a field which was already having issues attracting people).  That is the way in which these new laws in those states can hurt attract and retain OBs.

4 minutes ago, Phillyterp85 said:

The issue isn’t abortion.  The issue is the new laws that restrict a physician’s autonomy in the case of an emergency and the onus they put on the physician to prove that an abortion didn’t happen in the event that a miscarriage occurs.  It just adds much difficulty to the job and decreases incentive to go into the field (a field which was already having issues attracting people).  That is the way in which these new laws in those states can hurt attract and retain OBs.

I agree it already complicates the issue for OB's.  They were already in a situation where "doing something" rather than not was the preferred course even in cases where doing something did not effect outcome.

19 minutes ago, BBE said:

Wait.  Let me rush to Twitter and post "Obama care is killing health-care and people because they no longer have access to hospitals "...

I mean...you wouldn't be wrong. The Medicaid expansion has really destroyed the hospital industry.