CQ WEEKLY
– VANTAGE POINT
March 15, 2009 – 6:16 p.m.
Expanded Health Insurance Might Meet Shortage of Doctors
By David Nather, CQ Staff
What if Congress and President Obama achieve their goal of overhauling the health care system this year, only to find there aren’t enough primary care doctors for all those newly insured patients?
That’s a real possibility, thanks to long-term trends in medicine that have made primary care an increasingly unattractive option for new doctors. It’s not a front-burner issue yet in this year’s debate; everyone expects the big fights to focus on other things. But physician groups warn that the success of the effort could depend, to a large degree, on whether Congress does anything to make sure Americans have the doctors to go along with their insurance.
Otherwise, the first days after the passage of the health care overhaul could look much like the months after Massachusetts’ universal health care plan took effect in 2006, when newly insured patients overwhelmed primary care practices, leading to long waits for ever-shorter appointments.
“It really uncovers the Achilles’ heel of our health care system,” says Dr. Ted Epperly, president of the American Academy of Family Physicians. “We really are in a crisis right now over primary care.” Expanding health coverage without making sure there are enough primary care doctors, he said, would be “like giving out free bus passes to everyone in town, but you’ve only got three buses to put them on.”
The biggest problem is that primary care physicians are paid far less for their services than are specialists, although they might have the same amount of medical school debt to pay off. And lawmakers will be hard-pressed to fix that problem without setting off a lobbying war between physicians that could derail the overall plan.
In the few minutes that a specialist might spend performing a medical procedure during an office visit, “that procedure will get paid five to eight times as much as I get paid to spend those 15 minutes talking to a patient about hypertension, diabetes, and high cholesterol,” said Kevin Pho, a primary care physician in Nashua, N.H., who writes a blog about his experiences.
Though the American Medical Association predicts a shortage of as many as 40,000 primary care physicians for adult patients by 2025, there’s no universal agreement such a shortage is in the making, or what to do about it. Dr. David C. Goodman, a researcher at Dartmouth Medical School, says for instance that Congress shouldn’t focus just on adding more doctors. Most tend to go to places where there’s already a large supply, he says, so lawmakers should concentrate more on getting them to underserved areas and encouraging ways to better coordinate care.
Still, Goodman and most other experts agree that primary care physicians should be paid more fairly. In a review of health care overhaul ideas last November, Senate Finance Committee Chairman Max Baucus suggested that Medicare payments, which strongly influence insurance reimbursement rates, should be increased for primary care services. The catch, though, is that the Montana Democrat is insisting that any such increase should be “budget neutral,” meaning other physicians would have to get less.
Naturally, that’s not going over well with specialists — especially surgeons, who face their own future shortage for different reasons. “We support the increase in payment to primary care physicians, but you can’t take the money away from other physicians to do that,” said Christian Shalgian of the American College of Surgeons. Even primary care doctors don’t want their own payment increases to come at the expense of other physicians. Robert Doherty of the American College of Physicians argues that “we need to look at budget neutrality differently” — meaning that Congress should recognize that paying primary care doctors better will save money in preventable hospital and emergency room admissions over the long run.
It’s not clear how Congress will approach the problem, but physician groups say it will be critical for lawmakers to tackle the issue as part of the health care overhaul, especially since it would take years to produce more primary care physicians.
“There’s some understanding of the problem, but there’s not the awareness that we’d like to see of the urgency of doing it,” Doherty says. If that doesn’t change, Congress could find a lot of holders of free bus passes trying to squeeze onto those three buses.
Comments
Today was rice day, fifty-pound sacks of white rice in trucks bearing an elephant logo. The same happy elephant appeared on the bags, its head raised to the sky, the trunk curved like an S. "Elephant," Todd said. He said it because a laborer was staring at it intently. Which meant he wasn't working. "That's right," the man said. "I couldn't remember the word." He was the only other human at the loading dock this morning. The man didn't have a name, just a number, like the rest of the robots. Paris, at Night.
Why does the Gov not stop the extreme cost of Medicine and health care instead of programs to pay insurance companies and Drs and Hospitals and Medicine producers more.
Finally, the time has arrived to fix Americas Healthcare crisis, and Americas healthcare knightmare. Hundreds of thousands of you are killed needlessly every year by your healthcare delivery system in a rush to profit. And because of a rush to profit Hundreds of thousands more of you are needlessly dying from treatable illness that people in other developed and civilized countries don't DIE! from. Rich, middle class, and poor alike. Insured, and uninsured. Men, women, children, and babies. Additionally, thousands more of you are driven into financial ruin, and bankruptcy just because you, or one of your loved ones got sick or injured. And all of this is happening at a time when America spends twice as much of it's GDP (Gross Domestic Productivity) on health care than any other country in the developed world. Individual Americans spend about ten times as much on health care as any other people in the developed world. This is a CRIME AGAINST HUMANITY. AND IT MUST END! But before we can truly fix this healthcare crisis and disgrace, everyone needs to clearly understand what the problem is. And everyone needs to clearly understand the real enormity of the problem. The problem is that HEALTHCARE AND MEDICAL DELIVERY IN AMERICA IS SEVERELY CORRUPTED AND COMPROMISED BY GREED! AND THE PRIVATE FOR PROFIT MOTIVE. And it is corrupted, and compromised IN EVERY ASPECT, AND EVERY PLACE OF HEALTHCARE AND MEDICAL DELIVERY. Unfortunately for all Americans, compromised healthcare ALWAYS results in needless suffering, injury, disability, and or death. Which is exactly what is happening now in America in shocking numbers. Health care is NOT! a private for profit business. Healthcare is an essential public service. Like police, and fire. And healthcare is also a human right! PRIVATE FOR PROFIT HEALTHCARE IS AN OXYMORON, AND AN IMMORAL AND UNETHICAL PERVERSION OF HEALTHCARE AND HUMAN RIGHTS. So how do we fix this healthcare disgrace? I believe the fix for Americas healthcare disaster is essentially the same thing that every other developed country in the World has essentially done. "NOT FOR PROFIT, TAX PAYER SUPPORTED, SINGLE PAYER, AUTOMATIC, FREE UNIVERSAL HEALTHCARE FOR ALL. Essentially HR676 (enhanced, and expanded medicare for all). Just like every other CIVILIZED! country in the developed World has. There is no other way to truly fix and reform our current disastrous healthcare delivery system. All Universal health care systems work best when everyone participates. But I know that the healthcare lobby, and some politicians will try and undermine "Not For Profit, Tax payer supported, Single payer, Automatic, Free Universal Healthcare for all" by falsely claiming that it will limit your choice, and require you to participate. So, I propose that everyone be included in the national plan unless they choose to opt out. If you opt out and need medical care the national plan will insure your provider that they will be reimbursed under the rules for members in the national plan. But those who opted out, and their insurer will be responsible for the FULL! cost to the national plan for providing your care if you or your private insurer fails to reimburse the provider or the national plan in a timely manor to at least the standards of the national plan. Including reporting you to credit agencies, withholding of taxes, leans, and garnishment of wages for unpaid medical bills. Just like you have now under private for profit healthcare, and private for profit health insurance. Further, people who opted out will be required to provide proof of financial responsibility for future illness or be required to participate in the national plan. And everyone with children will be required to participate in the national plan. Or provide proof of insurance coverage on each child to the standards of the national plan. It will be against the law to report anyone in the national plan to a credit agency for unpaid medical bills. Frankly, only a dope would want to opt out of the national plan and opt to keep our current disastrous private for profit medical, and insurance plans. But they will be free to choose. The most important thing is that the vast majority of Americans that want the protection, benefits, and higher quality of a universal national plan have that choice. You see, one of the most important aspects of a universal healthcare system is easy access, and patient protection. This is accomplished by having a single payer without a conflict of interest in patient care. And by having a payer who has the power to enforce minimum standards of excellence in healthcare delivery for everyone in the plan. This is much of what Medicare does now for senors. "Aeger Primo" (The patient first). Unfortunately in our healthcare system the patient comes last. We are just a peace of meat to them. Cash cows to be slaughtered for profit. So this is IT! my fellow Americans, My fellow human beings, My fellow World Citizens. And my fellow Cyber Warriors. :-) The time has come. D day. H hour. HEALTHCARE REFORM THIS YEAR! Let no one stand in our way. Contact your representative and tell them you want "Not For Profit, Tax Payer Supported, Single Payer, Automatic, Free Universal healthcare for all. And tell them you want that choice now. Tell them you want President Obama's budget passed without delay. President Obama's budget is brilliant. And exactly what is needed now. President Obama, and his allies will need all the support you can give them. The healthcare lobby will try to take out his people if they can, like they did with Tom Daschle and Nancy Killefer. And they will try to neutralize President Obama's popularity, and political power. Or they will try to take him down someway. Don't stand for it. If they attack him. Go after them ten times harder and remove them from office. We had an election. And you the people chose President Obama's leadership, and change agenda. Let no one in government disrespect the will of the American people and remain in office. To President Obama, his Cabinet, the Congress of the United States, and the Supreme Court. I have noticed for some time a disturbing tendency for key members of your bodies to come down with illness, or medical problems at critical legislative times. This may just be coincidence. But I can tell you that there are a million subtle ways to medically injure someone just by doing nothing when something needs to be done. Or by doing things to someone when nothing needs to be done except to give them reassurance. I know for a fact that there are those that would have no qualms about hurting any of you to preserve our current disgraceful medical status quo. So, I recommend as a matter of national security that you enlist the help of a friendly power to regularly review, and oversee the medical care you receive from your local regular healthcare providers. Briton, France and many other countries have excellent medical providers. As well as Canada. Briton, and Canada may be less of a language barrier for Americans. Let's get this healthcare reform done now my fellow Americans. This year. Take no prisoners. God Bless All Of You Jack Smith -- Working Class :-) http://jacksmithworkingclass.blogspot.com/ (http://jacksmithworkingclass.blogspot.com/)
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