Few med school doctors entering primary care. They can't afford it, between the insurance companies ripping doctors off, Medicare ripping doctors off, and the hundreds of thousands of dollars of debt needed to complete medical school nowdays. Folks talk about waiting lists in Canada. But in much of the United States, you have waiting lists *now*, I could not get in to see any primary care physician on my provider's list in less than two weeks time when I lived in Phoenix.
Of course, there is a market-based mechanism available to deal with this: Just issue federal student loan debt forgiveness to any student who a) specializes in primary care at medical school, and b) practices primary care for at least five years, with no payments due for as long as he practices primary care. You'd see youngsters rushing to specialize in primary care big-time then. But that would be "socialism". In some alternate universe. Alrighty, then!
-- Badtux the Health Care Penguin
I'm fortunate that my specialty choice truly wasn't driven by money- it was driven by a passion for burn surgery; I regularly point out to my students and residents that I think it's spectacular that I get paid to do what I do- most days my job is that much fun.
ReplyDeleteThe idea that just primary care in trouble misses the mark a bit. A number of studies have shown that we're also in trouble in surgery in the next decade or so for many of the same reasons- Boomers retiring, and fewer students selecting specialties that are traditionally lifestyle unfriendly. Couple declining numbers with real threats of limitations on work hours for practicing physicians and our medical system would be brought to its knees.
Do I have a solution? No. But we're going to have to change the fundamental premise of how we practice medicine in America in order to address these issues. It's not a question of thinking outside of the box. It's one of throwing the box out completely and redesigning.
Yes, the entire system is sick right now. The profit motive has completely crucified it. When my mother entered nursing in 1973, there was no such thing as a private health insurance company -- all insurance companies were not-for-profit mutual companies, owned by their rate-payers. Private hospitals were generally not allowed by the states except when they did not practice any sort of critical care -- when my mother entered nursing, there was one (1) private hospital in the mid-sized city where we lived, and it specialized in cosmetic surgery. All other hospitals were non-profit municipal hospitals owned by people local to the community or by religious organizations such as the Catholic Church. Doctors made a good living, as did a lot of other people, but you did not have the Frist family of Tennessee getting obscenely wealthy by working the calculus, "if we cut hospital staffing by 20% we will lose $1 billion in judgements as people die due to lack of proper care but will save $2 billion in staffing costs" (no, I'm not joking about this, my mother got fired by HCA for ratting them out to state regulators for deliberately understaffing because they'd worked the numbers and figured out that the extra money paid out in judgements was less than the amount of money they saved in salaries and benefits).
ReplyDeleteEverybody made good money, and as a result, even though there was probably as many uninsured people as today, hospitals and doctors had the time and money to take on charity cases and it was rare that you had people dying because of lack of medical care. Of course, that was before all these expensive transplant surgeries and such became available, they'd transplanted a heart or two down in Houston but nobody ever imagined that transplantation would ever be anything other than an experimental treatment that didn't seem to work because of tissue rejection issues, but the point is that the system had the slack in it back then to provide better care to most people, whereas today it's pushed to the limits and those folks who got care in 1973 despite being uninsured get only the minimum care at the emergency room needed to keep them alive, then get thrown out on the streets again.
Point being, you throw the profit motive into the mix, and it degrades everything to the least common denominator. At the very minimum private hospitals and private insurance companies should be banned as a menace to the public health. But I'm not sure that even that would suffice to help rebuild the U.S. system of medical care back to where it was in 1973 when it really was best in the world (as vs. today, where it ranks somewhere between the Ukraine and Poland on all international comparisons), because we as a nation have become much more angry, vindictive, and violent, and no longer have the charitable instincts to care for those who are less fortunate than us...
- Badtux the Health Care Penguin
This is one of the reasons for why I have problems with the democrat's health care proposals. They want to increase the number of insured without a corresponding increase in medical professionals.
ReplyDeleteIf my arm-chair economics is correct, that would be an increase in demand without a corresponding increase in supply. Would that not mean that either health care would get more expensive or result in worse service in the short term?
Long term, I would have to consult my magic 8 ball.
It would result in lines and waiting lists, but the most critical patients would still get seen in a timely manner. Medical care isn't like ice cream, if there's a shortage what happens is that people who are on elective surgery lists for things like hip replacement get shunted aside to make way for people who need immediate heart surgery or they'll die. Look up north to Canada to the western provinces where there are not many doctors (e.g. Alberta) to see how that works, you'll wait a year or two for hip replacement surgery up there, which sucks if you need it but you aren't going to die from it.
ReplyDeleteOf course, if you're uninsured in the U.S., you currently have a 65 year wait for hip replacement (i.e., can't afford it until you're on Medicare) so on average you'll still have the same waiting list that you have today, except everybody will wait an equal amount of time instead of some having to wait 65 years...
- Badtux the Health Care Penguin
This is such a tragedy for our country. Tragic and embarrassing. I have a great primary care doctor and if I am sick, I am seen the same day. The longest wait I have ever had? 45 minutes, because some guy cut his hand open and he needed to be sewn up immediately. The doctor came in and APOLOGIZED to me for the long wait.
ReplyDeleteBut don't forget that while Medicare is ripping off some doctors, there are many doctors that are ripping off Medicare.
Apart from the previous problems mentioned with socializing health care, keep this in mind... Baby boomers are retiring. A twenty year projection proves the point that federal expenditures for entitlement programs (i.e. medicare & social security) cannot bear the burden. Even if we double our tax burden (what we pay Uncle Sam every year) over the 20 year period, these two programs alone will cause a gap (more money out than coming in) of unsustainable proportions. It has been projected by financial analysis, applying past trends to future projection (while hypothetically doubling the tax burden we pay), that the gap alone created by these entitlement programs will reach $68 trillion deficit. Only $13 trillion is Social Security. $55 trillion is Medicare (both social programs). Way to go oldies!!!
ReplyDeleteWhat can't happen, won't happen; it's a freakin' checkbook. Two solutions as I see it:
1. Create a population of healthy people; teaching these old-ass dogs new tricks... Like that is going to happen. How can you reach someone who has no skin in the game?
2. Those who take care of themselves contribute less to a system than, per say, the sedentary guy who stuffs his ass full of pizza every day or the diabetic that refuses to monitor his own health. Enforce health responsibility through sticks and carrots. You do whats right you get rewards, you do what's wrong you pay more. (as I see it, this is the only viable solution).
There is no cure-all pill. There will be no cure-all pill. Insurance should be there for catastrophe but it has taken on this whole new meaning of entitlement and right.
Take some responsibility people. Fix yourself, live well, spread the word. Contribute to your own health, keep making fun of fat people that could be skinny, and for god sakes get your preventative screenings - it could save your life... and the financial well-being of our unborn citizens.
Mark my words... If uncle same takes over health care, people that don't take care of themselves will bankrupt this country.
Riighhht. Like people not taking care of themselves has bankrupted Canada. And France. And the United Kingdom. And Germany. And Sweden. And ...
ReplyDeleteThe fact of the matter is that every single country that has nationalized health insurance -- *EVERY* single country -- spends less than the United States for health care, and most of them get better results for their spending. For example, on *EVERY* statistic France has the best health care system on the world -- the most doctors per population, the best outcomes, and so forth -- yet still spends only 75% of the money that the US currently spends on health care.
In other words, I call bullshit. Nationalizing the health insurance industry hasn't bankrupted any other nation, and there's no reason to think the USA would be any different. All it's ever done, worldwide, is reduce costs and increase the percentage of the population that receives healthcare. And that latter is probably a big part of the former, since people who get healthcare are healthier than people who show up at the emergency room on death's door because they can't afford a doctor or because they can't afford the medicines their doctor prescribed.
- Badtux the Health Care Penguin
Oh, BTW, the majority of the Medicare deficit is because of the new drug benefit. If Medicare is allowed to negotiate with drug vendors, that deficit is pretty much wiped out. But that would interfere with Bushevik cronies looting the public treasury, so can't be allowed. Alrighty, then!
ReplyDelete- Badtux the Medicare Penguin