I wrote a few weeks ago about how the debate in Washington surrounding Medicare largely ignored the issue of how the money in the program was being spent. The fix in that instance was an intrinsic one, but ignored the extrinsic question: can our current healthcare system afford the effective addition of tens of new millions of patients?
There is no way to comfortably predict what will happen in the next 10 years as our healthcare infrastructure adjusts to millions of new patients. The only thing that is certain is that quality of care will change as there will be a huge deficit of primary care doctors and healthcare infrastructure. The issue of healthcare infrastructure is a problem of transition of previously uninsured patients from the ER to the general hospital as well as increasing the amount of hospital beds available which is a gradual process that will likely take care of itself. The deficit of primary care doctors is an entirely different matter. In a recent opinion piece in the NY times, Dr. Peter Bach and Dr. Robert Kocher propose that by making medical school free and charging for specialty training, society can correct the deficit in a desirable manner.
This is a solution interesting in its simplicity. By making medical school free, more students would be willing to study medicine, and by making specialty training more expensive, more medical students would opt to do primary care (currently 10% of medical students opt to do primary care). Even though this plan will definitely increase the number of primary care doctors, it is difficult to say whether or not it will completely solve the issue.
First of all, it is unlikely that people will shy away from specialty training if it is made more expensive. Very few people enjoy taking on debt; however, people are willing to do so if they perceive that it will benefit them in the future. Therefore, making specialist training more expensive would not attack the root of the problem: hugely profitable compensation for specialists and expensive (many times superfluous) medical procedures. A shift in specialists to primary care requires not only a change in the compensation policy of Medicare but also a shift in medical ideology and culture which places great emphasis on procedures and holds specialists in an elite class above general practitioners. Only by equalizing the salaries of as well as the demand for specialists will an increase in primary care practitioners be seen.
Secondly, it is not entirely clear that having more doctors would improve the quality of the nation’s healthcare system in terms of the amount of money spent. This is because, in many instances, nurse practitioners and physician’s assistants are able to provide the same quality primary care for about 85% the cost of doctors. Because nursing school is already cheaper and takes less time, the deficit in the number of nurses needed will be much easier to fix. By allowing nurses to legally practice primary care on their own, the cost of healthcare in the nation would be dramatically lower.
The issue of preserving the quality of Medicare and the nation’s healthcare system while drastically improving quantity as well is staggeringly complex. In order to make sure proper care is provided to everyone while avoiding indefinitely beggaring the nation is a thin line to walk on. However, there are several clear steps that need to be taken immediately due to the passage of the healthcare bill: making sure any dollar spent is done so efficiently by getting rid of costly, ineffectual procedures as well as increasing the number of health care professionals available. How these aspects are accomplished is where the politics comes in.
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