Thursday, February 21, 2008

One Man's Proposal to Curb The Rising Cost of Health Care, Part 2

3. Government incentives to enter the most needed fields of medicine
Programs already exist that pay off loans for doctors who work a certain number of years in rural areas. Programs could also reimburse some measure of tuition or pay off some measure of loans for doctors to enter the fields in high demand that are not presently attracting as many doctors. There would be more primary care physicians available, helping people have greater availability. Loan payoffs could be tied to working in a given field as well as working in geographic or economic areas that need more doctors. If those programs already exist, then perhaps I am showing my ignorance. As it stands, new doctors are focusing on fields that earn them more money, and some further incentive to encourage more people to work in medicine as the field continues to have an increasing demand in years to come. I freely admit I am fairly ignorant on how these programs presently work to encourage doctors to work in rural areas. If they already include the requirement to go into certain fields, then good for them.

4. Remove the requirement that students must have an undergraduate degree to enter medical school
Once upon a time, students could go to veterinary school without completing a bachelor's degree. I know my former vet, now retired, did just that about fifty years ago. As it stands, for a person to become a doctor, they have to go through eight years of study and four years of residency to be a doctor free to practice on their own. If we removed the requirement for students finish the bachelor's program first, and instead required something more like an associate's in pre-med that involved all the necessary sciences, we could at least remove some of the time spent becoming a doctor. I know the enormous commitment to become a doctor has deterred many of my very intelligent friends from pursuing it, even some who planned all through their childhood to become one. If we shorten the path, we might hope to get more doctors.

5. Final Thoughts
In addition to these ideas, I also completely agree with Lawyer Mama that the system already pays for people's care, whether we like it or not. One commenter, SarcastaMom, on her blog post about universal health care, suggested we take the large sums spent on expensive care after the fact and invest it in more preventative care and education. I agree, but we need to come up with a good way to accomplish that shift in spending. Making it part of Medicaid and Medicare might make some sense, but not if it becomes "add-on" instead of "in-lieu-of" spending. My suggestion would be to require those on Medicaid to have an annual physical, which would help in curtailing major illnesses growing unchecked before they turn into something serious. Private insurance could also pay for an annual physical without regard to deductible as a further encouragement for people to get a better idea of how their general health is doing.

Doctors are already swamped in any office I visit, but with these government incentives, the cost of medical care to the consumer could and would go down and the availability would go up. These programs would also avoid the government taking over the role of insurance companies, but instead help the actual cost of medical care go down by removing the government-related costs from the equation. That's my two cents on the matter. Now I'd love to hear other ideas.

-- Robert


Julie Pippert said...

Doctors are swamped because they have to have volume to cover expenses because reimbursement rates are too low. In addition to this, they must keep current in their field with information about drugs, testing, new theories, new diagnoses and new diagnostic tools, and so forth. Unfortunately, too often the education portion is what gets cut because time is finite.

I can't get behind less educational requirements.

Undergraduate work sets the foundation, and medical school expects entrants to already be versed in the basics of science, anatomy, philosophy and so forth.

All professionals responsible for lives---including my husband's career---are required to have in depth education and continuing education as a license requirement. It's understandable to all why.

Many rural programs do attach to specialties.

Robert said...

I think you make some valid arguments, Julie. My point was that medical students could remove some of the portions of their undergraduate studies not related to their field. Cut down on some history and some English perhaps. It's just become a field that is time prohibitive to many people - quite a few of whom would make great doctors but just can't afford to take so long. Many other fields have continuing education, and I'm all for doctors furthering their knowledge in their given fields. We just need to find a way to attract more people to become doctors if we're going to increase the supply of medical care to people.

cubecutie said...
This comment has been removed by the author.
Suz said...

My sister is a pediatrician and I hold my PhD in English. Quite frankly, she's glad that she took the English courses that she did and I'm glad as well. The humanities courses that can be seemingly dismissed help teach critical thinking, writing, and communication -- all valuable skills for someone in the medical profession.

Robert said...

History happens to be my favorite subject. I absolutely appreciate my training in English, and I agree that it definitely has value for any person in any profession. I am simply proposing that some measure of courseload reduction could be considered to help doctors get through school and residency before age thirty. In the end, I know there is no simple solution to helping them get out of school faster, short of making a medical degree an actual undergraduate program (which won't work). I just want to bring up the idea to hear what others might propose, mainly. I think it is pretty noble to become a doctor anymore, simply because it takes so long to accomplish it. Unfortunately, many intelligent people capable of becoming doctors are not "noble" in their thinking and shy away from the time commitment. When someone could make millions selling off a ridiculous dot-com idea, why become a doctor at all? Even better, if you can become a millionaire out of high school (or now, with one year of college) because you have a particular skill at throwing a round ball through a hole teen feet off the ground attached to a piece of plexiglass, you can become a household name worth tens of millions overnight... Americans seem to have lost the ability to make long-term commitments, and certainly to plan long-term. We live in a microwave society, and we're just not satisfied with how fast "high" gets it done anymore. Where do we go from here, as more and more people need long-term plans for retirement, more and more people need medical care, and fewer and fewer people even have a savings account, and fewer and fwer enter the medical profession? Something has got to change.

Thanks for the input, though. I definitely do not look at English or History as "dispensible" classes. Anthropology, though... just kidding.