Re: America's Affordable Health Choices Act of 2009 - The USCHO debates
You could train general practitioners without going through all the rigors of medical school because they just need to know a little about a lot and refer you to someone else. (Obviously that would take a while to figure out the right system to use, and very few people would enter it to begin with so it would be a more long term solution) You could also provide financial incentives for people to become GPs like loan forgiveness etc.
FInancial incentives would be great. The supply and demand thing is negated by the insurance companies who set reimbursement.
Well, the article dealth primarily with a shortage of primary care physicisans (PCPs) as more doctors choose lucrative specialties instead. If the PCP shortfall comes to pass, then PCPs will be able to charge more for their services and so more people will want to stick with that route instead of specializing. An equilibrium will be reached where the supply of PCPs meets the level that people (private individuals and employers) are willing to pay for primary care. Will more or fewer people be able to see PCPs then? I don't know the answer to that, but I don't have a preconceived notion of whether that is a good or bad thing.
Turn the question around for a minute: if there weren't lots of covered people, how could there be a shortage of PCPs, since only covered people have one?
I am in Mass. Everything the guy says is absolutey true. We have only 1 Doc accepting new patients in the city and surrounding towns. We field a ton of calls looking for primary MDs. In Mass they passed a law that NPs have to be listed as primarys if they request. I am not listed because they cut the reimbursement by 15% if I am listed as the primary. They already reimburse at absurdly low rates. Not many people are going to be that stupid.
Let's play McLaughlin Group...
Issue #1 -- lack of primary care physicians. How do we get more doctors in the system?Stop rewarding the MDs that go into specialties extra $ for the same procedure we do for sig less cost. Irrigate an ear- 25 $. See ENT for same 200$ Reimbursement rates are ridiculously low for primaries. They are required to be the gate keeper but are not reimbursed for any of the management they must provide- ie all the extra work to get meds prior authed, referrals processed, coordination of care, etc
Utilize NPs and PAs. We are trained for primary care. The initial programs were in response to shortage of health care in the underserved populations. Now we are all underserved. The AMA consistantly tries to block any increase in the NP roll. Not so much the PA as they have control over that roll. They are currently trying to write us out of the proposed legislation as providers. The Mass Med Soc is trying to block any NP enterprise- that is why minute clinics are being blocked if rumor has it correct.
Issue #2 -- Does medical care cost too much? If so, how do you lower it? Redundant care, increase access to primary care. See # 1. If I can clear your ear why should the ENT get paid way more for the same thing? Less insurance and pharma control. Someone else mentioned the pharma influence. Many of them have a hand and glove relationship with the insurances. I think some are inter-dependent and possibly partially owned by same conglomerate.
More public health education and programs. 20 yrs ago we had health departments that did public health programs, education and basic messages to the general public. The current public health system is frighteningly inadequate. It cannot respond to any threat because in most small towns it is gone and in cities the response is to extremely narrow range of health issues like TB. (We used to report communicable illness and the PHD would follow up. Now they do nothing except enter the data.) The investment may be worth the baseline knowledge that can be created.
Consolodate resources for the underserved. Immunization clinics, basic screenings with referral if abnormality found.
Issue #3 -- (3rd rail) Tort reform.. Necessary or not? YES This increases costs on all fronts.
Issue #4 -- Competition. Apparently there is a federal law that says that health insurance cannot cross state lines. Should this law be repealed???
Only repealed if there are protections in place for the requirements such as basic screening. In Mass they have to cover GYN screen for example. I think the States are in control because there were such disparate views on what was necessary when they were considering Federal requirements. ( I learned about this but it was 25 yrs ago).
I also have some fears about John Q Public being thrown to the wolves when they try to chose their healthcare. If you have some education then OK but if you are dealing from a baseline of ignorance then it would be scary.
In OB we are taught that if someone has less than an 8th grade education their risk is much higher. I thought this was bunk- if a person is smart they should be able to overcome it. Unfortunately it seems to pan out. There are certain basic bits of info that we all take for granted that are the building blocks for other health decision making. If you don't have those a lot of the education we do seems to go right over the head, no matter how you explain it.
I see a parallel here with insurance. In order to ask the right questions you would need to know a question should be asked. Most of the folks posting on here have a basic knowledge and I bet a few of us would struggle. Do I think it is possible eventually - sure but I see the initial thing as a huge CF.
(This is totally discounting the fact that the billing people would jump off the nearest bridge unless they did some sort of standardization of billing codes, forms etc)
