Too see my primary care doctor for my regular check-up, I usually schedule the appointment 3 to 6 months in advance. But it's still possible see the doctor within one or two days for more pressing concerns. Adding more people to the ranks of the insured is sure to create some log-jams, but it may also open up more possibilities. Some doctors already have additional evening and weekend hours. Others are looking at team treatment, where doctors, nurses, dieticians, and pharmacists coordinate patient care. Also called a medical home, this type of coordinated approach, along with new technology, makes it easier to treat patients with chronic disease and multiple health issues.
The idea should provide better care at lower cost, but the way doctors are paid would have to change for the approach to be used more. There are proposals in Congress that would increase reimbursements to primary care doctors, but it would come at the expense of specialty care.
This is where health care reform gets tricky. Keeping reform "budget neutral" without tax increases means there will be winners and losers.
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Congress that would increase reimbursements to primary care doctors, but it would come at the expense of specialty care.
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How the expense of chronic conditions dwarfs the cost of rapid correction, quick treatment of acute situations and events. Could the mishandled event morph into chronic sorrow?
Would you guess that lot of chronic illness could be prevented by allowing seemingly insignificant acute problems to go first to the fully qualified specialist? With easy to obtain ancillary personnel and computerized records, the board certified dermatologist can sweep through literally hundreds of patients in one day.
With exponentially burgeoning power to wreak havoc or healing, is the generalist becoming a liability? With the advent of automobile and helicopter, is detour through family physician, nurse practitioner, physician's assistant, or student health nurse now becoming antiquated anachronism, a fading paradigm, a dangerous tradition? Have lobbyists and Congressional meddling prolonged the pain of this faded glory?
U B Judge
Another problem in the bold new world of mandatory insurance is the question of the lower middle class; those who make too much money for assistance but not enough to buy insurance. What do we do if they can't pay the penalty at the end of the year, bring back debtor's prisons?
I don't agree that increasing the number of covered Americans will provide better care. In fact, I think it's just the opposite.
If upwards of 40 million people will now be covered, it means many more doctors. That means medical schools will need to graduate more doctors. When you need to graduate more students chances are the quality of what's graduated is less. I personally don't want to put my health in the hands of someone who got through medical school on a curve.
If you cut reimbursements you're cutting revenue to the doctors. They have homes, beach homes, cars, country club dues and other expenses they'll still need to cover. If you cut their reimbursements they'll have to make it up in volume. They'll do that by squeezing more patients into a day and performing more allowable procedures. You can double the number of patients seen in a day but you can't double the number of hours in a day. That translates into less time per patient or procedure. How is that better care?
On this same program about the possible shortage of doctors and long waiting periods if all people were covered, one doctor stated that they would simply adjust if there was an increase in patients, perhaps different hours. Another statement was that if the doctor were allowed to hire other types of assistants--nurses, nutritionists,therapists, etc.--the one-to-one with the doctor could be cut back without decreasing the proper care.