Given the incredible structural similarity between the Massachusetts health care reform law signed by Mitt Romney and the new national Affordable Care Act signed by President Obama, the release of the annual physician workforce survey from the Massachusetts Medical Society has generated a lot of attention. But I would caution everyone involved that on issues like the impact ACA will have on ER use or physician availability, what has happened in Massachusetts might be a very poor guide to predict what will happen nationally.

Not only is Republican Paul Ryan’s Medicare privatization plan using basically the same general premium-supported exchange design that Obama’s health care revision does for the uninsured under 65, but both Ryan’s budget and “Obamacare” are nearly totally reliant on almost the same pathetic accounting trick of using poorly indexed caps on federal health care spending in the distant future to produce the bulk of their supposed deficit reductions.

In the last few days, several bloggers – among them Jon Cohn and Ezra Klein — have written faulty defenses of the health care bill. They used theoretical, counterfactual alternatives in defense of the health care legislation they’ve supported, calling to mind Voltaire’s classic, Candide. In it, Voltaire heavily mocks the extreme optimism of Pangloss, who concludes all is good no matter how terrible things are because we live in “the best of all possible worlds.”