Costly medical care results from legalized bottlenecks
Doctors are too few, due to the doctorsí lobbying association
We condense a 2007 article summarizing a doctor explaining why his kind is a vanishing breed: "Primary Care Physician Shortage" by James Joyner posted at Outside the Beltway (Nov 1). We cite other causes for the high cost and ways to bring them down.
by Jeffery J. SmithJJS: Doctors cost us trillions each year. And itís going up. Just the portion that the federal government is supposed to pay -- Medicare and Medicaid -- at their current growth rate will devour 20% of our GDP in 2050, more than today's entire federal budget of $2.8 trillion.
Part of the problem is prescription medicine, the patent monopoly vs. generic brands. Part of the problem is spendy new equipment used in the last months of a patientís life. A bigger part is the doctor shortage.
Why does it cost so much to see a doctor? When the question is price, the answer is always the same: high demand, low supply.
On the demand side, we get sick more than we should due to stress, mainly money worries overwhelming too little genuine leisure. And our polluted environment also assaults our immune system with every breath, every drink, and every morsel of food. Take that, cellular integrity! Plus, the Baby Boom has arrived at the age when one needs more doctoring.
To meet this need, many people want to practice medicine, but many canít. As a gift to the American Medical Association, states tend not to respect a doctorís license granted by another state or nation. Nor may a nurse perform a minor routine function for a patient who may need no more than a kind word and an over-the-counter aspirin.
OTB: Politics also keeps down the number of primary care physicians. Those are the doctors who provide more affordable medical attention than do specialists. Areas of the United States where primary care physicians deliver the most care have lower overall costs.
Yet the number of primary care doctors is plummeting. In 1949, 59% of doctors worked in primary care, but by 1995 that number was down to 37%. Over the past ten years, as many as one in five primary care providers have left the profession.
This trend started in the 1970s with the rise of HMOs. Instead of paying doctors fixed salaries, as Kaiser Permanente did, insurance companies paid them according to how many patients they saw and forced them to accept lower rates of insurance reimbursement. So doctors started to see more patients per hour and to feel burned out.
The drop in personal attention helped push patients to specialists. Patients now view their doctor mainly as a gatekeeper to the specialized care they ďreallyĒ need, even if more expensive. Often under-fifty patients with high-end insurance visit an array of specialists for mundane problems.
Some patients make unnecessary visits to emergency rooms. That by far is the most expensive way to deliver medical care. This also means that other patients with true emergencies, such as acute coronaries, are often not handled promptly or effectively.
About a third of physicians are over the age of fifty-five. Young medical professionals arenít replacing those who are leaving. Between 1997 and 2005, the number of U.S. graduates entering family practice residencies dropped by 50%.
Today, students from medical school graduate with about $130,000 in debt; choosing a high-paying specialty will allow them to pay it off many years sooner. Median income for primary-care doctors was $162,000 in 2004, the lowest of any physician type. Specialists earned a median of $297,000, with cardiologists and radiologists exceeding $400,000.
For docs, $162k is too little money for too much work. The workweek for primary-care doctors has lengthened, and they are seeing more patients. Thereís also a prestige gap between primary care and the specialist.
Licensing and subsidizing also hold down the supply of doctors. Because of the lengthy schooling and apprenticeship requirements, one doesnít become a licensed physician until oneís thirties. And apprenticeship still entails suffering, despite medical residents being limited to 80-hour weeks since 2003, ending decades of 100-plus-hour weeks.
Worse, the American Medical Association lobbied Congress to cap the number of available school and residency billets. Medicare pays for at about 80,000 a year. Medicaid, the state-federal health care program for the poor, and the Veterans Administration finance another 20,000 residents. Teaching hospitals pay for a small number of residents without government assistance. The caps worsen the artificial shortage and thereby keep doctor salaries inflated.
So letís increase the number of slots available in our medical schools and the number of medical schools. Training 20% more physicians would put us on par with France on a physicians-per-100,000 basis.
JJS: Much more than more doctors is needed. We also need to live in a healthy environment -- so make polluters pay -- and to enjoy life -- so pay ourselves an extra income apart from our labor by sharing the value of sites and natural resources.
Jeffery J. Smith runs the Forum on Geonomics.
The Paradox of Government-Monopoly Medicine
The Struggle for Affordable Medicines
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