For John, BLUF: Obamacare has not fixed the medical system. Nothing to see here; just move along.
Some from the Democrat side ask for the Republican Plan for Health Care. Fair enough.
My plan, and I am a Republican, thus a Republican Plan, is to keep the pre-existing insurance system, with expanded coverage for those who can't afford insurance, and to add, via the Public Health Service,♠ a large number of health care providers, to include physicians, physicians assistants and nurse practitioners. My estimate from months ago was 80,000 in total, to cover low density areas, be they rural or urban. Frankly, I find that to be the big hole in the PP&ACA.
From CBS San Francisco we have this article on "Medical Homelessness".
Rotacare, a free clinic for the uninsured in Mountain View, is dealing with the problem firsthand.Here is the nub of the problem:Mirella Nguyen [who] works at the clinic said staffers dutifully helped uninsured clients sign up for Obamacare so they would no longer need the free clinic.
But months later, the clinic’s former patients are coming back to the clinic begging for help. “They’re coming back to us now and saying I can’t find a doctor, “said Nguyen.
Dr. Kevin Grumbach of UCSF called the phenomenon “medical homelessness,” where patients are caught adrift in a system woefully short of primary care doctors.So, where is the plan from Senator Harry Reid and Representative Nancy Pelosi to fix this problem? Crickets.
Hat tip to the Instapundit.
Regards — Cliff
♠ One of the Seven Uniformed Services of the Federal Government (i.e., PHS, USAF, NOAA, Army, Navy, Marine Corps and Coast Guard).
A worthwhile discussion to have. While insurers squeeze doctors on their fees, and lawyers hound them for potential malpractice so that other insurers gouge them on their coverage, doctors find they can't cover the service on their medical school debts in a private practice position--ergo, there aren't nearly enough doctors for the rest of us. Given the problem is magnified in remote and otherwise economically challenged communities, huge swaths of the country cannot get care at all, and one can usefully argue that the same law that required the phone company to string poles all the way out to the farm might be usefully re-purposed to require insurers (yes, I said insurers) who profit from the Affordable Care Act to be responsible for care being available in all communities. This could be done via subsidy to GP reimbursements in under-served areas.
ReplyDeleteThere, now your Republican plan has a Libertarian amendment, despite that amendment being anything but Libertarian in its design. Compromise is good for everyone, so I thought I'd go first.
YES!
ReplyDeleteRegards — Cliff
I would much prefer going Craig H's route than populating a Federal agency. The answer to this problem is not more government. Moreover, the USPHS could quite easily be converted into a white collar indentured service organization. As I recall from my years as an AF medic, very few AF physicians remained on board after serving their commitment.....unless they were a Frank Burns type. There is no incentive to excel as a military or quasi-military doctor. Everything you can do is covered extensively by policy.....often as the only reason that something is done in a particular way. In Britain, your doctor's name might as well be a number.
ReplyDeleteAmericans need to embrace the reality that medical care is first and foremost a profit making business....with the theory begin that the better you are professionally, the more you can charge for your service. While there IS a great deal of altruism in the practice of medicine, that never gets discussed. My family doctor in the 50's and early 60's provided a lot of care for which he was never paid, and he didn't pursue it because he knew payment was contingent on giving up something of greater importance.
A world class medical delivery system must be first a profitable venture......capitalism must be at work. You can have insurance companies hire their own docs and facilities....or you can go ala carte. But, you cannot ask someone to give up 12 -15 years of their life and shoulder hundreds of thousands of dollars in debt, and not allow them to seek the best employment to catch up.
The idea of NP's and PA's stepping in has some merit, but extreme limitations. I don't think you want to have a PA or an NP perform neuro- or vascular surgery on you.....and you likely will want the best there is available.
In the meantime, while political agendas are played out, activists vent their spleens, we continue to lose physicians at an unprecedented rate. When my primary care doc entered UMASS Med School in the late 70's, there was something on the order of 30 applicants for every chair. Today, chairs go vacant.
Legislation will not change that.