Monday, April 27, 2009

Thoughts on health care

It seems that a shortage of doctors will be an obstacle for the Obama administration, according to this NYT's article:

Obama administration officials, alarmed at doctor shortages, are looking for ways to increase the supply of physicians to meet the needs of an aging population and millions of uninsured people who would gain coverage under legislation championed by the president.

The officials said they were particularly concerned about shortages of primary care providers who are the main source of health care for most Americans...

To cope with the growing shortage, federal officials are considering several proposals. One would increase enrollment in medical schools and residency training programs. Another would encourage greater use of nurse practitioners and physician assistants. A third would expand the National Health Service Corps, which deploys doctors and nurses in rural areas and poor neighborhoods.


I have a few thoughts. First of all, who the heck wants to be a doctor anymore? The regulations and bureaucracy are stifling. Perhaps making practicing medicine less onerous would be a good step in putting more doctors to work, but that's hard to fathom, given the push towards nationalized health care and even more regulation.

Second, it is a concern that more nurse practitioners and physician assistants would be used. While they are often good, they should not substitute for a doctor in many instances. I spoke to a radiologist recently who said he was slowly getting out of the field and that the coming trend would be for nurse practitioners and others to fill in and that soon, that is mainly who patients will be seeing. Those of us with complicated medical histories should be concerned, if not alarmed.

Finally, many people have no idea what they are getting into here with the push towards nationalized health care. Most people have never really been sick, and haven't experienced what it is like to have to wait for care, be seen by those who are incompetent or inexperienced, or who are rushed and unable to find the time to sit down and figure out what is going on medically with a patient. It is about to get a whole lot worse with more government intervention, not better. But at least some people can feel good about themselves, and tell themselves that at least all will be covered--and a Utopian ideal can be marked off the wishlist.

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23 Comments:

Blogger Cham said...

Medical schools have long been regulating the number of students in the United States to keep the number of doctors low so that salaries and compensation stays high. Presidents before Obama have tried to address this issue before with little success. Right now there are a fixed number of doctors and they cost lots of money every time they do anything, so I can understand why the medical community and the insurance industry who pays the bills are desperately trying to migrate toward the use of nurse practitioners. Either the AMA relents and allows for more doctors and more medical schools or we are going to be looking at seeing many more nurse practitioners in the future. You can bet your last bippy that the AMA is fortifying its federal lobbyists as we speak.

7:17 AM, April 27, 2009  
Blogger javadoug said...

Ha Ha, those Democrats are a bunch of dummies, to fail to take into account basic laws of economics, but then, to them, it's not about health care, it's about control of every aspect of people's lives. It's about tyranny, but they won't admit it.

I can't wait to be MANDATED to buy health care that I basically can't even use, because while I'm working, I won't have time to stand in line to get my health care. So only people who don't work will have the time, beautiful!

In a way, though, it's those twenty-something numskulls who will suffer most, because that is the demographic that most often goes without health insurance. And coincidently they are the ones that voted overwhelmingly for Obama. Can't wait to ask them: How's that working out for ya?

:)

7:33 AM, April 27, 2009  
Blogger J. Bowen said...

I have a few thoughts. First of all, who the heck wants to be a doctor anymore? The regulations and bureaucracy are stifling. Perhaps making practicing medicine less onerous would be a good step in putting more doctors to work, but that's hard to fathom, given the push towards nationalized health care and even more regulation.It's so easy to see how this, with a couple minor adjustments, could be said of men and marriage.

Second, it is a concern that more nurse practitioners and physician assistants would be used.

...

soon, that is mainly who patients will be seeing.
When I applied for my VA disability, I was sent to the VA for an exam that was performed by a nurse practitioner. Maybe it's possible that I would have still received the same disability rating and maybe it's not. Either way, I have no complaints.

Most people have never really been sick, and haven't experienced what it is like to have to wait for care, be seen by those who are incompetent or inexperienced, or who are rushed and unable to find the time to sit down and figure out what is going on medically with a patient.If most people were forced to go the VA for their care for basic care the idea of nationalized health care would be revolting to them.

7:48 AM, April 27, 2009  
Blogger fred said...

You imply that this has taken place just now, under the Democrats but was not an issue under the GOP...you ought to be careful in referring to a nationalized health care system. Just where do you see such a proposal in the works?

In my area, doctors now use para anasthesiologists--but only for certain procedures; lawyers have para, and on and on so this is simply an expansion of what has been taking place.

Many doctors do not like the paperwork that comes with insurance companies running our system! see for a comparison how well the V.A. hospitals function before you blame "the system." In your practice, do you deal extensively with insurance companies? sure. Are you leaving?No. Why? because you are willing to put up with crap for a better good.

8:11 AM, April 27, 2009  
Blogger TMink said...

"If most people were forced to go the VA for their care for basic care the idea of nationalized health care would be revolting to them."

Spoken like someone who has actually gone to a VA facility.

"see for a comparison how well the V.A. hospitals function before you blame "the system.""

Spoken like someone who has not actually gone to a VA facility.

Trey

8:24 AM, April 27, 2009  
Blogger Larry J said...

Imagine if you had a well intentioned but poorly skilled handyman who did work around your house. He means well but seems to botch every job he takes on. Would you hire him to be the contractor in charge of building your next house?

That's the situation with government ran health care. Look at the health care for the military, the VA, Medicare, and Medicaid. Are any of those programs well ran? Do they consistently give high quality care?

How about this for a proposal: let the government prove it can do a good job running health care programs before letting them expand on what already exists. Let them prove they can be more cost efficient while still providing quality care. I suspect we'll be waiting a long time, though.

9:01 AM, April 27, 2009  
Blogger Ima said...

Fred,

Nationalized health care IS in the works. You just don't know it. First, Obama and the Democrats expanded S-Chip bringing approximately 11 million children onto government health care rolls. While we certainly want our children covered, almost 50% of these children already had private insurance. Why would we start our children out on government dependency? That's a bad precedent. Second, buried in the stimulus bill was the creation of a new national health care board designed to look at "comparative effectiveness research." This board was modeled after the United Kingdon's health board NICE which is the rationing body of the government and determines what drugs and treatments the government will pay for based on cost effectiveness, not clinical effectiveness. Also buried in the stimulus bill was government funding to computerize American citizens' medical records to be stored in a database...which the GAO has said has no security.

A nationalized health care proposal is not only in the works..it is here, incremental step by incremental step.

9:37 AM, April 27, 2009  
Blogger DADvocate said...

Fred, I hope you lambasted the NYT for writing that article this April instead of last April. The NYT's timing implies this is Obama's problem. How horrible!

We do need more medical students but nothing the government is doing now helps that. Another factor not mentioned yet is that making sure doctors don't make too much money will attract the best and brightest too. (sarcasm off) How can anyone look at the current government run healthcare programs and believe that more of this is good?

9:39 AM, April 27, 2009  
Blogger gunnypink said...

If memory serves me correctly, was it not the Clinton administration that told us there were too many doctors running around the country, and they were wanting medical schools to cut back on the number of students being allowed in, and to graduate?
We don't need no more government do-gooders trying to fix something that ain't even broken.

9:55 AM, April 27, 2009  
Blogger fred said...

it is here? Heatlh system that is nationalized? ; And the TV and the NY Times do not know it. Bu't it is here? wow. Last I heard there was to be a choice...not a dragging into a system. Odd that the Times, so hated by libertarians and conservatives (the same?) is suddenly the source of information...I thought this paper lefty crap! Now it is paper of record?

10:22 AM, April 27, 2009  
Blogger Cham said...

We have nationalized health care. It's here and a lot of people use it. Medicaid, Medicare, VA, whatever. Think of it as the Payless Shoe source as opposed to going to Nordstroms to buy your footware. When you go to Payless you find the shoe box you need, you try on your own shoes, the shoes work and nobody tells you how wonderful you look. When you go to Nordstroms somebody measures your feet, tell you that you beautiful in your new shoes and then shows you a pair of socks that match the shoes. I buy my socks at Wal-Mart, I don't necessarily need the full service and the accolades, and neither do a lot of other people. Unfortunately, the AMA has many people convinced that if their doctor didn't spend 5 years at Duke getting trained then he isn't worth visiting.

10:49 AM, April 27, 2009  
Blogger MiaZagora said...

This administration is just silly. What does Obama know about health care, other than his wife used to work in administration in a hospital? Nothing, that's what. We already have Medicare and state Medicaid programs - why not try to improve those instead of nationalizing it?

If health care is nationalized, there are going to be even fewer people who want to spend eight years in med school just to go to work for the government.

Secondly, that business about electronic records. I know doctor's offices that have been on paperless systems for quite some time now. In fact, that's one of my husband's side jobs - installing these computer systems. Why Obama thinks doctor's offices won't do it without a nudge from the government is beyond me - other than it will make it easier to ration health care when it becomes nationalized.

When my husband was out of work, I went to the Health Department for my yearly check-up. It wasn't as nice as my regular doctor's office, and the exam was performed by a nurse practitioner. I received good care at a wonderful price. If I had a chronic condition like high blood pressure or diabetes, I would probably want to see a doctor. PA's and nurse practitioners are great for minor illnesses.

In fact, more and more doctor's offices - including our pediatrician's office - are getting PA's. One of my girls saw the PA for a terrible cold, and he was perfectly fine. My point is, like the electronic medical records "idea" - Pres. Obama is a day late and a dollar short. The use of PA's has been gaining in popularity for at least the past 20years. Just more wasteful spending and duplication of what is already going on.

11:46 AM, April 27, 2009  
Blogger DADvocate said...

Fred, you just don't get it. (Of course, that's been obvious for a long time.) When we can take lefty crap for the commie NYT and use that same lefty crap to show that lefty crap is lefty crap, we're in hog heaven.

12:18 PM, April 27, 2009  
Blogger MikeT said...

Unfortunately, the AMA has many people convinced that if their doctor didn't spend 5 years at Duke getting trained then he isn't worth visiting.All that this has resulted in is cases like what happened to my mother where a well-credentialed old fart who had little local competition never updated his medical knowledge, and ruined the recovery of her shattered collar bone. The ignorami who speak about mandating best practices through "evidence-based medicine" have never had to deal with such basic failings as a doctor not having to keep up to date because the market was artificially uncompetitive.

12:23 PM, April 27, 2009  
Blogger jimbino said...

Did you ever try to get Medicare or Medicaid as an Amerikan living overseas?

12:56 PM, April 27, 2009  
Blogger Joe said...

This comment has been removed by the author.

6:57 PM, April 27, 2009  
Blogger Joe said...

Nationalized health care or not, the cost of getting basic medical care annoys the shit out of me. Just getting stitched up is silly expensive. Then you have all those prescriptions which are perfectly safe but require bullshit visits. Why do my wife and daughters need to see a doctor to get refills on their birth control? (Yes, there's the breast exam/PAP smear test excuse except the research shows they are pretty much a waste of time and money.)

I have terrible acid reflux due to a specific medical condition. Thank god Prilosec went OTC, but why the hell are the other brands still prescriptions? Why are ED drugs prescriptions? Why is there even a "prescription strength" ibuprofen (are people really that dumb not to know to just take 4 generic ibuprofen?)

I think well over half of medicine is a total scam that caters to a throng of hypochondriacs and goes to great effort to turn the rest of us into hypochondriacs with help from the law suit industry.

6:59 PM, April 27, 2009  
Blogger Learning Curve said...

1. Eliminate extortionary lawsuits by giving punitive damages to a charity of the loser's choice.

2. Pay the GPs based on actuarial tables for their set of patients, instead of paying them piecework. People choose their own GP and can switch at any time.

8:15 PM, April 27, 2009  
Blogger J. Bowen said...

[i]Nationalized health care or not, the cost of getting basic medical care annoys the shit out of me. Just getting stitched up is silly expensive.[/i]

Are you doing any kind of comparative shopping? I went to a clinic because I thought I had a broken bone in my foot and was in and out for less than $200. I was seen by the doc, had my foot x-rayed, and had the x-ray looked at by a radiologist all for one flat fee. Had I went to the hospital I'm sure that I would have been charged an arm and a leg (nobody that I talked to on the phone knew what the cost of being seen by a doc would have been).

9:49 PM, April 27, 2009  
Blogger Joe said...

Are you doing any kind of comparative shopping?Yes, by virtue of reality. I've had to take myself and two of my kids to various places to get stitched up, including doctor's office, emergency room and an extended hours clinic. The cost differences were huge and increased at several times the rate of inflation in just the last 15 years--the emergency room visits were especially annoying because the emergency room was almost empty both times (and because I had no insurance at the time.)

The last time I got stitches (at a clinic) it was billed at $180. That's just crazy.

12:03 PM, April 28, 2009  
Blogger Bolie Williams IV said...

Even if there are more medical students, they still won't want to become GPs. GPs get the lowest pay and the longest hours and are the least glamorous. So unless GPs can get paid more (which will make primary care even MORE expensive) someone is going to have to force people to become GPs...

12:53 PM, April 28, 2009  
Blogger randian said...

Many doctors do not like the paperwork that comes with insurance companies running our system!Most of that paperwork is government mandated.

We already have Medicare and state Medicaid programs - why not try to improve those instead of nationalizing it?I have a better idea: get rid of Medicare and Medicaid entirely.

4:16 PM, April 29, 2009  
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11:29 AM, May 24, 2009  

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