A thought on healthcare reform

A journey of a thousand miles begins with a single step. - Lao-Tzu

These were the words of a Chinese master, thousands of years ago, and they apply today as much as they ever have.

Our president, today, went to Chicago to talk to the American Medical Association about his plan for healthcare reform. There are many people who are excited about Mr. Obama's plan, including himself, his wife, and his kids. Most everyone else is not too keen on it.

Why?

Well, it is very expensive, for one. Insuring the 42-plus million people who currently do not have health insurance is not cheap, even if you only consider the administrative costs of setting up such a plan. The actual medical costs to "plug" each and every one of these people into the medical system will be staggering. Even if it were only $1 each, that is over 42 million dollars! Believe me, it won't be $1 each. It will be more on the order of $100 or more each. So, already, we are looking at a startup cost of over 4 billion just to get all the uninsured to see their PCP once. Nevermind the opportunity cost of getting any prescriptions they may need, etc. You get the point.

Then there is the problem of who is going to see all of these people: who will be their PCP? There are not enough Internists, Family practitioners, Pediatricians, and OB/Gyns available to see the patients we already have within a decent time frame. Ever tried to get in to see your PCP the same day? Likely, you were unable to do so. How is our system going to handle the surge of new patients needing PCPs, and, because they now have insurance, trying to get all of their chronic medical problems they have neglected for years "looked at."

Not very well, I can tell you.

So, we have no money, we have no manpower for this great plan. Already a problem.

Next, Mr. Obama wants to cut payments to hospitals (many of whom are already running in the red and could collapse at any time) by about 700 billion dollars over the next 10 years, across the board. Are you kidding? So, we don't have enough PCPs to take care of these patients with chronic medical problems, causing them to ignore any early symptoms they may have, prompting the need for emergency care as their health deteriorates, and then we are going to cut funding to hospitals. Where are these millions of people going to get care?

That is the HUGE question, and the giant elephant in the corner in this healthcare reform talk.

1. Train more physicians: ok, we'll start today training more PCPs. That takes a MINIMUM of 7 years (4 years of medical school and 3 years of Internal medicine, Family medicine, or Pediatrics training, 4 years of OB/Gyn training). What incentives are there to be to encourage medical school matriculants to enter primary care? The money sure as hell isn't there, compared to any specialty. Pediatrics is consistently the least paid specialty, and probably one of the trickiest, as your patient cannot even communicate effectively for the first several years of its life. Gerontology would be the same story, opposite end of the life span. Mr. Obama wants to, as part of his plan, increase the pay for PCPs, but where is this money going to come from? Some say take it from the specialists, but you can bet they will fight that. It is not fair to say to a cardiologist (or a surgeon, etc), "your work is no longer worth what it was yesterday, here is a smaller paycheck."

2. Let midlevels have more independence: This is exactly what the Nurse practitioners want to happen. They have been spewing out shitty study after shitty study proclaiming they can perform primary care just as well as a physician for years. Now, they have invented a new degree so they can be called "doctor," the DNP (see my prior posts about the DNP), to further blur the lines between nurse practitioner - a mid-level practitioner position - and physician. The problem with this, aside from everything, is they do not know what they do not know. I blogged once about how one cannot recognize something unless one is familiar with it. This is the perfect example of how true that statement is. Aside from that, cost of care often goes up when midlevels are involved.

ugh, more to come. This topic is too big to finish in one post. Everyone would get bored before I finished.