The temperature of the health reform debate is rising as August gets under way. There have been some fairly angry protests at Congresspeople’s “town hall meetings.” On the lefty blogs, and even the White House, this is evidence of a right wing conspiracy.
HCAN’s Richard Kirsch said a couple of months ago, “Those attacking reform are really looking to protect their own profits, and [Rick Scott is] a perfect messenger for that. His history of making a fortune by destroying quality in the health-care system and ripping off the government is a great example of what’s really going on…. We cannot have a better first person to attack health care reform than someone who ran a company that ripped off the government of hundreds of millions of dollars.”
Right-wing activists teaming up with a right-wing scam artist to ensure the public can’t have an honest discussion about health care. It’s sad, in a predictable kind of way.
I would also note that left wing Obama supporters can’t have an honest discussion, either. I have previously posted an extensive analysis of what I think a good model for reform might be. I don’t think the command economy model, which was the Clinton Plan and seems to be Obama’s plan if they will take the time to read the bills, will work in the long run. What this approach attempts to do is to control prices by controlling what doctors and hospitals can charge, and then to control utilization by rationing the care that is underpriced. In World War II, there were wage and price controls that survived into the post war years. This was accepted by most citizens, although there was a lot of black market manipulation, because we were at war. Richard Nixon attempted to control the first stirrings of inflation with wage and price controls. Even when he removed them as a bad idea in 1973, he left them on medical services. You cannot write regulations that will take the place of the market. The Soviet Union found this out but we seem doomed to repeat their failures.
The trend in the Democrats’ legislation is to put all adults into Medicare and then control utilization by rationing care, especially for the elderly. What do we know about Medicare as a system so far ? I spent about eight years on the Board of Directors of CMRI, the Medicare peer review organization for California. The last two years, I was chair of the Data Committee. After I retired, I went to Dartmouth for a year to learn how to measure quality in health care by analyzing data from the Medicare claims database. I thought there would be a lot of interest in quality measurement as part of attempts to control costs and reduce waste. I was wrong. The government people were no more interested in this than the insurance companies, maybe less. What they wanted to do was to juggle the reimbursement system to control costs.
In 1989, the government passed a law revising how doctors were paid in an attempt to discourage expensive specialist care and encourage primary care. How did that work out ? It certainly cut payment for highly technical procedures, like those I used to do. What did it do for primary care ?
Not so good. It turns out that paying people less while telling them how important you think they are doesn’t work well.
Over the past 25 years, America’s growing and increasingly diverse population has surpassed its number of trained health personnel.
In 2006, the Association of American Medical Colleges recommended a 30 percent expansion in the number of physicians trained, in order to avert a doctor shortage — a shortage predicted to be 20,000 by 2015, according to the PricewaterhouseCoopers Institute.
The nation may see a shortage of 1 million nurses by 2020, according to the U.S. Department of Health and Human Services.
Today, Georgia is in dire need of more health professionals from more diverse backgrounds.
Georgia ranks 37th among the 50 states in the number of doctors per capita, according to the American Association of Medical Colleges Center for Workforce Studies.
This in a state that has the third highest rate of obesity among youth, ages 10 through 17 (37 percent), and an adult population ranked 14th heaviest among the 50 states.
In efforts to recruit more physicians into primary care fields, appropriate reimbursement should be given for diagnosis, counseling and other cognitive-based services.
Health professions students must be able to obtain their?education without incurring student loan debts of $200,000 or more.
This debt drives many new graduates into higher-paying specialties or more-affluent communities rather than primary care in rural and urban settings.
What is not mentioned is that payment to primary care physicians is crappy and declining. The nurse shortage has two basic origins. Back in the 1970s, the national nursing organizations decided that RN nurses should all have college degrees. They brought pressure to bear with politicians to close hospital-based diploma nursing schools and to make all prospective nurses go to college. The result was a disaster that nobody talks about. When I was a medical student in the 60s, the LA County Hospital had a nursing school that turned out well prepared nurses who were in tremendous demand. The school close about 1974 and almost all hospital nursing schools were gone soon after. What replaced them were the junior colleges which trained nursing students who got their clinical experience in hospitals but they never got the level of daily practical experience of the old diploma schools. There, they had dormitories and all expenses were paid. Many stayed at the training hospital when they graduated. The only reason that system went away was the egotism of the nursing societies who wanted to require a college degree to become an RN.
Reimbursement of primary care doctors has never been raised as they were promised. Instead, they were tricked into supporting cuts in reimbursement for surgery, an early form of rationing. They bear the burden of the system and their incomes have suffered. Medical students are rational people and have avoided primary care with increasing determination. They now find that their place is being taken by “allied health professionals” including nurse practitioners and physician assistants. I think this is a good idea so long as the role of the physician is kept primary. Many patients are happy to be seen by nurse practitioners. They do need supervisions, though. For a while my ex-wife was working for a local GP as a nurse practitioner. She had a master’s degree and had trained well. Still, she used to call me every day or two about a question that she couldn’t get the GPs to answer for her. Eventually, she was replaced by another MD because the practice administrator told her that MDs were “more versatile.” Of course they are but proper use of NPs is still a good use of resources. There are now small clinics located in drug stores and even Walmart stores, staffed by NPs. Most of these have a list of common conditions that they are equipped to treat. They do not accept patients with other conditions or symptoms, suggesting that they see an MD.
Eventually, we will evolve into a system where people can seek medical care that they can afford and that is convenient without waiting lists and rationing, other than by what we choose to pay. I fear that all these budding innovations will be choked off by premature descent into a command economy system that will freeze all the players in place. This happened in Canada but now after 25 years, private practice is breaking out in Canada.
Accepting money from patients for operations they would otherwise receive free of charge in a public hospital is technically prohibited in this country, even in cases where patients would wait months or even years before receiving treatment.
But no one is about to arrest Dr. Brian Day, who is president and medical director of the center, or any of the 120 doctors who work there. Public hospitals are sending him growing numbers of patients they are too busy to treat, and his center is advertising that patients do not have to wait to replace their aching knees.
The country’s publicly financed health insurance system — frequently described as the third rail of its political system and a core value of its national identity — is gradually breaking down. Private clinics are opening around the country by an estimated one a week, and private insurance companies are about to find a gold mine.
Let’s not make a huge mistake and freeze our country into an ill-advised move now when real reform is possible. It may happen regardless of what the government does but it will be harder if we are frozen into a Canadian style socialist system.
I am really tired of the exageration on both sides of the issue. I think that we need to do something about health care, but I think that there are lots of things the government can do other than take it over. One thing would be a simple change to the IRS code which allows Drug Companies to write off advertising as a cost of business. This would stop them from spending so much money on ads that frankly anoy me greatly. Every day a new drug and a new disease.
Sparky Organic Coffee Guy