WASHINGTON, November 30, 2013 – It is clear that the American system at its best is indeed the best on earth. But it is not always at its best. Certain common sense deficiencies stand out.
Shortage of health practitioners
First is the shortage of doctors and nurses and other health care providers. There are whole areas of inner cities and rural America, for example, which have no physicians at all. Why? Because our medical schools do not graduate enough doctors to serve the population of the United States. Why not? Lack of intelligent students? Lack of students who are motivated to give their lives in service to their fellow man? Not at all.
The reason is lack of money!
Medical education is so lengthy and so costly in this country that very few students can afford to go to medical school. There is a lot of talk about spending more government money on health care. One very good use of taxpayer funds would be to offer medical and nursing school students free tuition, open to all qualified applicants. We do it for the military, why not for doctors and nurses?
The cost would be miniscule compared to the Department of Defense or agricultural subsidies.
This policy would have a massive return on public investment. More doctors would increase coverage of the population – perhaps there should be a requirement for a graduate M.D. and R.N. to spend 2 years in a “no-doctor zone”. More doctors would increase competition for the patient dollar. More could devote themselves to research.
New blood, new ideas, new openness to change. The quality of care would go up, and the cost would go down – a mantra we have been hearing a lot lately.
A second issue in quality of care that seems very obvious is this: medicine should become patient-centered instead of doctor- (and hospital-) centered. How in the world can this goal be accomplished?
When Kaiser Permanente was invited to the model city of Columbia, Maryland in the 1960’s, developer James Rouse (a visionary if there ever was one) was asked, Why the invitation? His answer was to this effect:
“I like my doctor calling me up and asking how I’m doing, instead of me waiting until I’ve got a problem and then making an appointment for two weeks later, waiting half a day for him to see me, and then spending 5 minutes with him.”
The early versions of managed care held this patient-centered practice as a sacred goal (unfortunately lost somewhere along the way). But the idea is still valid. Our notion of medicine is disease-centered, not health-centered. So is the reward structure. No physician gets paid for well people, only for sick people. No hospital gets money for well people, only for sick people.
How can we change that?
The answers to that question are really the true test of “health care reform” in America.
Of course, the answers are not at all clear. There are, however, some ideas that resonate. If we have a lot more health care professionals, we could divide them into different groups. One of those groups could be the doctors and nurses who operate on a model of social workers – keeping track of patients, making house calls, getting to know the family histories and challenges.
A version of this idea is currently taking shape in the form of a subscriber service. The patient pays a flat fee to the clinic on an annual basis, and is free to stop in at his convenience. Each team has a quota of patients or “clients” as they are called, and these clients are their only responsibilities. Of course, as in so many other instances in our current health care system, the fees are quite hefty and therefore limited to the more affluent. However, it can be done.
The key to better quality health care in America is more medical professionals.
Legislation is needed to offer free medical and nursing school scholarships to all qualified students.
We have government programs to feed the hungry; to provide health care for the elderly; to protect the innocent. We can provide health care access to the poor and the rural.
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