For John, BLUF: With PP&ACA we have the cart before the horse. Nothing to see here; just move along.
Someone has comment about the PP&ACA in the following, edited, manner:
From the micro level I can assure you that my clients are fearful and mistrustful of a government they consider to be out to screw them six ways from Sunday. A few have simply shut down their businesses. Most have retrenched and moved some employees to part time to avoid temporarily ACA's most draconian provisions.I think this writer has hit on a key point. We are increasing the number of people who will seek routine medical care from a physician vice an Emergency Room. There may be cost savings in that, but given the fact that we already face a shortage of key medical providers, physicians, physicians assistants and nurse practitioners, it is dubious. What in the PP&ACA will force such medical providers toward the northern tier great plains states or northern Maine, or into inner cities?The bill is about population control not health care. The simple logical fallacy that you can improve national health care by and make it cheaper by forcing more people on fewer physicians and compensating those physicians less for the extra work would be laughable if it was not destroying the best healthcare in the world.
Even my least astute clients have figured that out.
If our politicians lack the logical skills to work out the same problem, we certainly need a new crop.
Since opponents of "ObamaCare" are often accused of having no plan of their own, here is mine.
I believe we have put the cart before the horse. The problem is a shortage of medical personnel and a way to fund them in areas of low density. My guess is that we are short some 80,000 Physicians, Physicians Assistants and Nurse Practitioners. We need them in the upper great plains, upper Maine and inner cities. I suggest we fund them through the Public Health Service, one of the seven uniformed services. Not that I wish to see the Federal Government funding healthcare, but that I see this as a problem needing a solution and Federal Money (extracted from all of us) is a way of beginning to put in place the proper economic incentives. And, the Public Health Service being a uniformed service they can be assigned where needed.
The current bill seems to be leading us in the wrong direction. Health care is, as some point out, one sixth of the US economy. On the other hand, today about 18% of our GDP goes to the central government. Some economists think that number is close to the tipping point where economic freedom starts to go away, with very unfortunate consequences for all of us, not just in terms of medical care, but in terms of the overall economy.
Regards — Cliff
Our problem and our failure is to concentrate on single aspects of a larger problem. Medical care and its delivery is a gigantic ecosystem in which, numerous components operate inefficiently or not at all. By fixing one, and not addressing the others is to invite and endless whackamole game and exacerbate the plight of many who are already bereft of any meaningful medical care.
ReplyDeleteInsurance companies are bad...but they are not the villain. They are merely filling an economic necessity and following an economic principle that profit must be included in any successful economic system...a fact lost on the Federal government. The insurance companies are problematic in the ecosystem because they are paying the costs of a gargantuan and disparate population of providers, each of which is trying to recover THEIR production costs and make a profit. One might spend the balance of their lives whining about the profit margin of this or that component being far to rich, but that is likely not to change until the nature of the niche they are filling...the need they are satisfying....changes.
You can reactivate the USPHS, but all you are going to do is exacerbate a problem already suffered by the VA and military medicine. Given the costs of a medical education (which include lost wages during years of residency), government wages simply delay repayment until later years when that repayment becomes even more burdensome. Most specialists today enter practice owing somewhere in the vicinity of $250,000 and have no assets at all...perhaps a rather old car with an unpaid loan...certainly not a house.....and in many cases...need to borrow more money just to GET INTO a practice. Once there, the specialist is faced with the need to employ a workforce each member of which has their own economic liabilities to cope with. That we have specialists at all is by itself amazing. A neurosurgeon who gave me the benefit of his expertise a month ago often performed up to 6 complex neurological surgeries each business day and often emergency surgeries through the weekend. His home in Nashua was boringly middle class...not the mega-mansion that the proles would have us believe every money hungry physician aspires to.
One of the very important cons to activating a USPHS is that it was never THAT successful to begin with and was essentially shut down because of its vast inefficiency vs cost. From a patient perspective, the quality of care bordered on minimal. Because of compensation issues, "good" and "excellent" practitioners avoided PHS like the plague.....as they do today in the VA system.
If you want to make medical care more "affordable" you must alter the costs of delivering it to begin with. That means that each component of the medical ecosystem must be evaluated and scaled back in terms of its delivery costs. Pharmacies, big pharma, nurses, nurse's aids, medical aides, hospital janitorial services, linen services, medical equipment suppliers and so on ad infinitum must be scaled back in their costs. But then, you do get what you pay for. If you want prime oats, you must pay a fair price for them. If you want oats that have already been through the horse.....those are considerably cheaper.
The reason that Obamacare is going to implode is simply because it is unaffordable.
BTW...the good samaratism that once provided some significant relief in our society has disappeared. The attitude today is....the government should do that for me. Don't feed the wild animals in the forest because you will train them to come into communities with the expectation of free food...and will thus not forage on their own. And yet, we pour billions...more than we pay for national defense...into giving free food and other things to poor folks. And we wonder why it grows.