News & Politics

Rant

Health Care Reform Will Cause a Doctor Shortage

Posted 23 months ago|20 comments|754 views
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With the assumption that Congress passes a health-care reform bill of some kind and it is signed into law, we could see, about 30 million uninsured people who will suddenly find themselves access to doctors. The health-care overhaul is certain to add to the problem by flooding doctors' offices with new insured consumers looking for healing. One only has to do the math and see that when giving millions of people insurance, you will find a shortage of doctors.

Congress placed a limit in 1997 on the number of medical residencies in order to hold down Medicare costs. Medical residencies are hospital training that is required for all doctors. The number is limited because Medicare pays for most of that training. However, even without health-care reform our nation is experiencing a doctor shortfall because of an aging population and their demand for medical specialists.

Funding for residencies through Medicare was setup in 1965 when the U.S. Government was about to extend health coverage to about 19 million Americans. Unfortunately, Medicare has grown to 45 million last year and the cap was placed to control spending. Currently Medicare pays about $100,000 a year per residency, at a total cost of about $9 billion. The Medicare cap affects about 90,000 residencies at U.S. hospitals.

Medical schools have tried to accommodate by adding 3,000 first time students by 2018, but the cap on residency has not been lifted. Without that cap lifted, the demand will continue to out pace the supply. According to the U.S. Health and Human Services Department, there are nearly 17,000 fewer primary care doctors than what was required for most urban and rural areas. By the year 2025 many experts expect that number to rise by as many as 160,000.

Many within Congress are trying to get amendments submitted to the health-care bill to increase the residency cap. Adding about 15,000 residencies to that cap would cost Medicare currently about $1.5 billion. However, hope is thin on the amendment passing as Congress is wrestling on keeping the total cost of the health-care reform bill down.
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Out Of The Box
Out Of The Box
 Moderator
23 months ago: Just wait until the next wave of Medicare recipients hits the rolls, all 78 million boomers poised to retire within the next ten to fifteen years.

But the healthcare guys say that the bill will shore up medicaid, but only by getting a four year head start on actually paying anything out.

Yes, they plan on taxing us for four years before the health care plan actually does anything, so they are giving six years of coverage for ten years of premiums.

Come on, you liberal bastions of hope and change. Tell me how that works.
markbyrn
markbyrn
 Moderator
23 months ago: A better question is what would you bastions of conservatism do? The '78 million boomers poised to retire within the next ten to fifteen years' are going to do so whether it's Dems or Republicans in charge.

When Bush was in, he pushed for and got what the Wall Street Journal called the "Medicare fiasco" and a "Medicare giveaway." I believe Bush called it compassionate conservatism. See this illuminating article entitled 'On Fiscal Conservative Hypocrites'

http://www.realclearpolitics.com/article...
Out Of The Box
Out Of The Box
 Moderator
23 months ago: Bush pushed for and got what I call "sucking up to the Democrats, to get votes and support for his other not-so-popular agendas".

You really have to stop living in the past.

In the present, I asked for you to tell me how that works, and as usual, you just pointed the finger back at Bush.
Out Of The Box
Out Of The Box
 Moderator
23 months ago: His other "not so popular" agendas and programs included the TARP fleecing we got, with major Democrat support. You think there was some kind of back-room dealing going on then? **** for tat? You scratch mine and I'll scratch yours?
markbyrn
markbyrn
 Moderator
23 months ago: I'm not living in the past - I'm reminding you of it since the GOP partisans seem to have a continuing case of amnesia. Also, you didn't answer my question - what's the conservatives solution to the 78 million retiring baby boomers?
Out Of The Box
Out Of The Box
 Moderator
23 months ago: I'll answer this in a sidebar, to hopefully maintain continuity despite your attempts to sidetrack the focus away from the point I made, and the question I asked.

Conservative views on how to manage the insurance problems:

Make interstate commerce legal in the health insurance business, promoting competetiveness, driving down costs by forcing innovation and efficiency.


Line item tax deductions for citizens who purchase their own health insurance

Allow all people to pool their resources in health care copoperatives to purchase lower cost group plans, which would operate on the same principle as stock market investments, and spread the risk/reward ratio thinner so that if one part fails, the others can hold it up.

Bring back State run hospitals, for the people who can't afford health care insurance. Tax the population on a State level to pay for it.

Now I've answered your question. Do you have an answer for mine? Or are you going to spend all your time redirecting and reminding me of what Bush did?
Out Of The Box
Out Of The Box
 Moderator
23 months ago: That wasn't the question. The question I posed, and still unanswered, is how is ten years of premiums for six years of services going to work after the first ten years? Especially considering that the workforce is declining and the retirement force is scheduled for a massive increase.

Anyone with a logical viewpoint want to answer?
markbyrn
markbyrn
 Moderator
23 months ago: ...Bring back State run hospitals, for the people who can't afford health care insurance. Tax the population on a State level to pay for it...

So your answer is taxes and do at the state level instead of the federal level. Sounds like you're quibbling and getting into the state's right vs federal conundrum. I think we've beat that horse in the past.

...Make interstate commerce legal in the health insurance business, promoting competitiveness, driving down costs by forcing innovation and efficiency...

You pull that off a GOP website - driving down costs by forcing innovation and efficiency? Sounds like corporate gibberish but what a fabulous contradiction you made. On one hand, you want the individual state's to be solely responsible (intrastate) and yet on the other hand, you want interstate insurance because it drives efficiency. Amazing!!

Out Of The Box
Out Of The Box
 Moderator
23 months ago: No, I said bring back State run hospitals, as in "charity" hospitals, to administer to those who can truly not afford any kind of insurance. And that is not the entire answer I gave, no matter how you try to twist it. Once the interstate bans are lifted, and the co-ops are established, prices will naturally fall as businesses compete for your dollars. Everyone knows that this is a fact of business.

Also your statement:"On one hand, you want the individual state's to be solely responsible (intrastate) and yet on the other hand, you want interstate insurance because it drives efficiency" is completely erroneous. I never stated that I wanted the individual State to be solely responsible for anything except charitable hospitals. For that matter, it wouldn't bother me a bit if they were Federal hospitals, that administered only to the truly destitute and were paid for through donations and taxes.


Do you have an answer for my question yet?
markbyrn
markbyrn
 Moderator
23 months ago: ...No, I said bring back State run hospitals, as in "charity" hospitals...

No, you didn't say anything about charity; you said, "Tax the population on a State level to pay for it" - bet you wish you could take that back.

...Do you have an answer for my question yet?...

No, I don't and neither do you - you're a jelly fish of partisan confusion.
Out Of The Box
Out Of The Box
 Moderator
23 months ago: Ok, my exact quote:

"Bring back State run hospitals, FOR THE PEOPLE WHO CAN'T AFFORD health care insurance. Tax the population on a State level to pay for it."

If that's not charity, then what do you call it?


Then your comment:

"No, I don't and neither do you - you're a jelly fish of partisan confusion."

I do have an answer to my question. The question was and is:

"How is ten years of premiums for six years of services going to work after the first ten years? Especially considering that the workforce is declining and the retirement force is scheduled for a massive increase."

The answer is: It won't work. It's all smoke and mirrors, designed to trick the populace into continuing the entitlements we already have in the short term, with no way of keeping up in the long term.

"...you're a jelly fish of partisan confusion."

Typical. When all else fails, and you can't divert attention or change the subject, break out the name-calling.
markbyrn
markbyrn
 Moderator
23 months ago: I called you confused because you first said tax the people, and than claimed it was charity. Charity is voluntary and tax is compulsory - if you're taxing people, don't call it charity.

Sorry OOTB but I'm not one for swallowing simple solutions to complex problems and what exactly are your credentials? Do you have a masters degree or PhD in economics by chance? Are you Jeffrey Sachs in disguise? If there was simple pat answers, they would have already been implemented.
Out Of The Box
Out Of The Box
 Moderator
23 months ago: So you'd rather trust in a more complex solution to a complex problem. So we'll just go with a solution that's so complex no-one can understand it, and trust someone else to tell us what's good for us. That may be good for hive-mentalities, but it just don't wash with me.
Out Of The Box
Out Of The Box
 Moderator
23 months ago: See, that's how far it has come. The attitude that the people don't have a choice in the matter. And when you're giving something to someone who could not otherwise afford it, but needs it to survive, regardless of where it comes from, it's still charity.

char·i·ty
n. pl. char·i·ties
1. Provision of help or relief to the poor; almsgiving.
2. Something given to help the needy; alms.
3. An institution, organization, or fund established to help the needy.
4. Benevolence or generosity toward others or toward humanity.


I also don't need a degree in economics to know that if a ten year program needs a four year headstart to get through the remaining six years, it most likely will not survive the next ten years, especially knowing that the engine pushing it is running out of gas.
markbyrn
markbyrn
 Moderator
23 months ago: ...So you'd rather trust in a more complex solution to a complex problem...

Everything should be made as simple as possible, but not simpler...Albert Einstein
TheLegendTomWing
TheLegendTomWing
 Administrator
Philadelphia, PA
23 months ago: OOTB, I find myself disagreeing with you a lot of the time, but I'm going to take your side on this. Although I would wonder about companies getting to the point where they are, as the federal government says, "too big to fail."
Out Of The Box
Out Of The Box
 Moderator
23 months ago: Tom,

"companies getting...too big to fail."
Good point, one that most people, including me, failed to address. What would you suggest? I am thinking better anti-trust regulation and oversight, full disclosure to government auditors, perhaps even a quota system that would evenly distribute known at-risk clients between the providers based on their overall clientele.

I wouldn't be in favor of any kind of Insurance-insurance, like the FDIC is to the banks, but maybe somebody could figure out how to make that work too.

(You disagree with me a lot of the time? When you do, chime in! I would welcome and value your input.)(young whippersnapper!) ;>)
TheLegendTomWing
TheLegendTomWing
 Administrator
Philadelphia, PA
23 months ago: I would say let the companies operate in regions. I'm not sure how banks do it, but I know, for example, TD Bank (Formerly Commerce) operates in 3 states (i think), so maybe group tri state areas, for my area that would be PA, DE, and NJ. That way there is more competition, but there isn't some large conglomerate that's "too big to fail." I don't think government oversight is the answer, that's usually just used as an excuse for finger-pointing politicians when they try to explain their mistakes. For example, a man who worked with Bernie Madoff tipped off the SEC something like 10 times over the span of a few years and they did nothing about it. Plus then you have corporations getting involved in litigation because of privacy laws and such, which would cost the taxpayers even more money.

As for not chiming in, i do my best to keep up with all the stuff on here, but most of the time I'm squeezing it in between going to college full-time and working full-time, so i comment when i can!
Out Of The Box
Out Of The Box
 Moderator
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Altruist
Altruist
Eugene, OR
23 months ago: Good rant. I agree that we need more doctors. The AMA should increase the number of internships allowed and should also make it so interns don't have to serve 40 hour shifts. That is just dumb and dangerous to patients. The funding needs to be changed so the doctors don't graduate hundreds of thousands of dollars in debt. That way more can afford to be GP's instead of specialists that can charge more.

In the meantime the shortage will not be as bad as you state because the 31 million people are not denied access to a doctor now. They just go to emergency rooms and free clinics. Once Health Reform is passed things will be phased in so the major portions will not occur until 2014. We have a little time to graduate more docs.

If all else fails we can borrow some doctors from Cuba.
23 months ago: Have any of you talked to the physicians that plan to quit?
Retire early? Go into other fields? Research...?
That have had enough of bureaucratic intervention in what for some (if not many) of them really has been a vocation, and not just a job? But even the most devoted can be worn down.
Yes, by and large, physicians make a very good living...for, by and large, taking on responsibilities for the well being of folks of which politicians and lawyers do really not have the slightest inkling.
And they are, in almost every case, brighter people.
Notwithstanding the few who pimp their talents and procedures in catering to the vanities, most know far more of the real life and death issues that face people everyday than the most loquacious of the bleeding heart pol.
And I have yet to meet one who thinks this mess bodes well for either their profession or their patients.
The ability of a man/woman to bear being bossed around by the ubiquitous clipboard people is inversely proportional to both his innate intelligence and education.
If you doubt this legislation will not create more agencies, more bureaucratic oversight, more financial and legal mazes to be navigated, you are sorely mistaken.
If you think doctors exist in a vacuum unaffected by what they know is the caprice of their inferiors (read lawyers) and will just blithely bear what their own talents and intelligence can help them escape...again, you are sorely mistaken.

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