The LA Times points to the dog in the manger in healthcare reform:
The main reason for the shortage of primary-care doctors is that Medicare, Medicaid and private insurers don’t pay enough for the work they perform. The current system generally reimburses providers for what they do to their patients, not how well their patients stay, which means it undervalues immunizations, routine checkups and other services that can ward off or mitigate ailments. As Dr. Ted Epperly, president of the family physicians group, has noted, insurers will pay a lot to amputate the leg of a diabetic patient, but not so much to provide the services that might have prevented the amputation. Consequently, the U.S. has a lower percentage of primary-care physicians (about 30%) than other industrialized nations. Worse, the number of med-school graduates choosing primary-care fields is declining rapidly, dropping by half since 1997.
Not enough primary care physicians and inelasticity in supply means that treating more people, e.g. the uninsured or those who are currently treating emergency rooms as their primary care providers, will cause further rationing of something that’s already rationed.
Right now the Medicare system provides a substantial annual subsidy for each and every medical resident in the country. In my view we should stop subsidizing the medical education of other specialties entirely in favor of subsidizing primary care specialties. That would provide at least some inducement.
WARNING !! Yet another personal anecdote. If you are tired of these, avert your eyes now.
The LA Times writer’s observations are correct as I know them. As my father’s patient population “matured” they migrated to government funded payment. Read: less money paid to the doctor. He didn’t care. He entered medicine for the independance the profession offered, and to “do good.” His patient population was his extended family. But he observed that government remuneration for “procedures” exceeded that for primary care. (Lobbyists, you know.) And he observed that increasing government intervention was killing the profession. (Well, duh.)
With high paying alternative career choices for the industrious and clever, and a worsening environment (tort threats, general public disdain) for the primary care physician, is it any wonder we have a shortage? (Dave, your admissions theories aside.)
Is there anyone on this blog site who can imagine that increased government intervention into the health care arena will solve this? (What with control of salaries on the radar; and with the tort lawyers the #1 contributor to the Dems. Please. Spare me the boring arguments.)
Dave, your observation is correct. Stop the government directed subsidy (market malformation). But we have the mother of all malformations on the horizon.
If “universal health care” passes there will be two health care markets. That for the rich, and the government program for the masses.
God I’m glad I’m in the former. I pity the latter.