Thursday, June 10, 2010

One Final Comment on Healthcare

Healthcare reform has largely dropped out of the news since passing. Although I believed that as a political matter, it should have been made to vest, there was one potential policy advantage in waiting till 2014.

People like Sarah Palin and Michelle Bachman insist that it will lead to death panels in the sense that if everyone has access to healthcare, it will have to be rationed and people will be denied essential services. The obvious retort is that if some people don't have access to healthcare at all, they are by definition being denied essential services. In effect, what Palin and Bachman are saying is don't let anyone else get access because it will take services from me. Not a very edifying argument, but one with a certain appeal.

But is it true? For life-threatening conditions or serious illness, no. We already have mechanisms in place to ensure that no one is left to die in the street. Most of the uninsured entering the system will be reasonably healthy. But what the Massachusetts experience has shown is that, although critical care will not be much affected, primary care will be severely strained. The influx of 32 million people, fairly healthy, but without regular care up till then, will be a serious strain on our primary care system.

That is the advantage of a four-year lag. It will give us time to prepare by training a large number of primary care providers to cope with this sudden influx. We should be working on that between now and then. For instance, we should vastly increase scholarships to become nurse practitioners and physician assistants. (These two categories are qualified to give primary care to a generally healthy person, but they are less expensive and quicker to train than family doctors). We should be advertising, urging people to follow these two careers because they will be growth industries in a few years. And if we are unable to train enough primary care providers on our own, we should start admitting more immigrants who can offer primary care.

So, what are we doing now to prepare for the influx? So far as I can tell, nothing.

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