Romneycare, the Poor, Doctors and Nurses

[IBCoupe]

In what might be a preview of what is to come once universal health insurance becomes a reality nationwide, Massachusetts is discovering that, despite having health insurance, the poor are still seeking out emergency room treatment. It could be that old habits are dying hard, but it is more likely that a shortage of doctors is driving this.

Because the number of patients seeking out preventative care has gone up (the desired effect) but the number of doctors available to see them has not, long waits and, in some cases, poor service drives the poor away - they can't afford as well as others can to wait for preventative care when they can go into the emergency room later. The shortage of primary care physicians has been known for a long time, and will become an even bigger problem in the years to come, if not from increased health insurance coverage, then from population increases.

So what do we do? One of the obvious solutions is to get more doctors: subsidize medical school and/or cap tuition costs at medical schools (and everywhere else, gosh-darnit! They've got up with absolutely no relation to inflation, but that's another discussion). Part of the problem is that, while there are probably a great many Americans who are qualified to become doctors, given the right education, there also probably exists a sizeable portion of that population for whom medical school is simply not economically feasible.

Another, perhaps less obvious solutions, is to give qualified nurses more power and larger roles in an office: like ordering tests or writing prescriptions. This is an unpopular option among doctors, but nurse practitioners have been shown in states like Oregon to have a great effect on the improvement of care when such expansions of their roles. But this comes with its own problem: there's a nurse shortage, too, but not for lack of trying. There's a huge interest in the nursing profession in this country, but there's just not enough nurses willing to teach - there's a lot more money in practicing than in teaching. So, what can we do? We could subsidize the cost of leaving the practice to teach, but that might be an expensive move. Alternatively, we could create a professional oath to spend a certain amount of time teaching, similar to the pro bono oath lawyers take to spend a certain amount of time providing service at no cost or at least at a discounted rate.

These are just some ideas. What are yours?

[stebo0728]

Just real quick, my ideas are more private sector. No subsidies. Incentive is to make medical practices appear less reprehensible as career choices.

1) Lots of doctors figure out that they can make better money with less risk doing other things. Malpractice insurance is so expensive, and even then there is the risk of frivalous lawsuits driving you out of business. Tort reform is a must, end the frivalous suits, get malpractice rates back down. I know alot of GYN's around here have dropped their OB branch due to the increased malpractice insurance due to childbirthing complications, they just rather not deal with it.

2) With measures like ObamaCare, doctors are starting to see their role, their time and intellectual investement, as no more than a resource manipulable by the government. They perform their services only to be strong armed on rates by medicare, so they stop accepting medicare and medicaid, but then ObamaCare comes along and suddenly everyone is going to be on the equivalent of medicaid, so what now? Lets just quit doctoring and do something else with my life. Repeal ObamaCare, start working with drug companies to get rates for medicine and equipment down, and stop trying to "from each, to each" the doctors to death.

Just some quick thoughts, and not a complete plan to fix everything, but an indication of the direction I lean.

[IBCoupe]

1) Tort reform, as it's commonly framed, is a red herring. Yes, there are frivolous lawsuits. But the system already weeds them out through market forces - it's not in a lawyer's interest to take on a frivolous lawsuit. I don't see how you can make that argument and argue that we need less government involvement.

And there's some weight to the suggestion that rising premiums have nothing at all to do with actual malpractice claims: http://www.consumeraffairs.com/news04/2 ... ubcit.html

"The hard, factual evidence cannot be any clearer: We have no medical malpractice lawsuit crisis in America," said Joan Claybrook, president of Public Citizen.

"Insurance companies may be padding their bottom lines by jacking up rates on doctors, but it is not because of patients seeking relief for bad medical care through our courts. The true crisis continues to be in inadequate measures for patient safety and incompetent medical care by a small number of physicians," she said.

Some other statistics from that link:

Adjusting for population growth, the number of payments per 100,000 people has fallen from 5.85 to 4.91 from 2001 to 2004, a decline of 16.1 percent. Since 1991, the number of payments per 100,000 people has dropped by 9.2 percent, from 5.41.

Total malpractice payments increased from $2.1 billion in 1991 to $4.2 billion in 2004. However, from 1991 to 2004, the inflation-adjusted amount has changed little, rising from $2.1 billion to $2.3 billion - an average annual increase of only 0.8 percent.

The median size of payments from judgments appears to have soared, from $125,000 in 1991 to $265,000 in 2004. But adjusted for inflation, the median payment grew from $125,000 in 1991 to $146,100 in 2004 - an average annual increase of only 1.2 percent.

And this little bit, right here from July of 2009, I think is the clincher:

In describing the study's findings, Hunter said, "Our study shows that states that have passed severe medical malpractice tort restrictions on victims of medical error have rate changes similar to those states that haven't adopted these harsh measures. Finally, our research makes clear that medical malpractice claims and premiums have almost no impact on the cost of health care. ... If Congress completely eliminated every single medical malpractice lawsuit, including all legitimate cases, as part of health care reform, overall health care costs would hardly change, but the costs of medical error and hospital-induced injury would remain and someone else would have to pay."

Joanne Doroshow, executive director of the Center for Justice & Democracy, said, "Medical malpractice claims are down. Premiums are down. Meanwhile, insurers are raking in money and belittling the fact that hundreds of thousands of patients are killed or injured due to medical negligence each year. Many states have already afforded health care providers extensive legal protections for reckless or unsafe medical care. Proposals in any national health care bill that will take even more money out of the hands of injured patients and into the pockets of insurers are utterly indefensible."

You think premiums are a problem? I don't. But even if you do, you're nuts to think that the lawyers or the patients are to blame.

2) That's some really fuzzy argumentation right there. Do you have anything to back up this feeling that doctors have?

[audtatious]

Just have the Gov mandate it. Solves everything.