The Hole in Health Care Reform

I had a breakthrough thought late last week as I listened to a speech by Iowa State Senator Hartsuch (also an E.R. doctor) about politics and health care legislation. What I realized really shocked me, both for its simplicity that I somehow missed, and for the enormity of the consequences that I see. What it all boils down to is supply and demand! Read on...

Yes, this simple law of economics I believe is going to forcefully break any Health Care reform, beit Republican free market systems OR my dear, sweet Democratic universal health care.

When you call your doctor to setup an appointment, how long do you sometimes have to wait? Days or Weeks? If you show up as a walk-in to a primary care office, or emergency room, what is the wait time? When you do see your doctor, how long do you actually get to spend with them?

In general, there is already a crunch on availability of physicians, physician assistants, and nurse practitioners. There are even documented and projected shortages of these healthcare providers, and of nurses nationwide, especially in rural, native american, deep urban, and prison settings.

So what happens when an already limited supply sees a dramatic, and fairly sudden increase in demand... like getting 47 million more Americans health insurance? Well, you have 2 options: raise prices or ration services. Granted, not all 47 million will start using the system dramatically, but there will be a definite bump, especially if the health care reform plans actually achieve a system focused on prevention (more, regular checkups or interactions with healthcare professionals) as opposed to reactive treatment? The issue is that healthcare access may actually be harmed by the health care reform initiatives being proposed! Improving efficiency through paperwork reduction, 3rd party best practice forums/quality initiatives, and electronic medical records will only help so much.

This is a tough issue. Even if you try to influence medical students to go into primary care, it is still a 7-10 year delay (med school & residency years) before seeing the increase in the number of practicing primary care doctors. P.A.'s have a bit shorter training but still require physician supervision. N.P.'s, like Physicians suffer from a lack of available spots in schools. Regardless of profession, all classes of health care professionals lack available clinical and residency (physician) training sites. My school, DMU is currently is a desperate search for clinical rotation sites for 3rd & 4th year med students, just like every other medical school.

So, how do we fix health care with the issue of health care staffing figured in? Well, the big problem with health care is a lack of access to affordable, prevention focused medical care & guidance. To fix access I believe, as stated previously, that we need government to provide a low cost insurance alternative to existing insurance companies to induce some competition and give everybody health insurance. The rest of the access issue can be addressed by increasing the number of Title VII residency slots, clinical training slots, medical & nursing school slots, medical & nursing school faculty, and dramatically increase the funding of loan repayment programs and the National Health Service Corps. Those changes need to be made first such that the supply will be preparing to meet the demand.

And guess what? After I had this realization last week, I found out that the U.S. Senate Health, Education, Labor & Pensions committee held a hearing on Feb. 12th to discuss this exact issue. The testimonies shared by experts in this area can be found at:

'Addressing Healthcare Workforce Issues for the Future' Feb 12, 2008

We'll see what comes of it.