Some Thoughts on Health-Care Policy
I think the “health care problem” is more nuanced than government vs consumer driven because I think in part, consumers have driven health care in a bad direction(government hasn’t helped). A lot of this is anecdotal, as I work in the health care field and have seen it (on a micro level) across the US and in a few other countries.
From my perspective, Arnold Kling is dead right when he talks about an abundance of health care. We love it, we love doctors and more importantly, we love specialists. And so, as market forces are want to do, doctors move into specialties but instead of lowering the price of those specialties, we kept the price the same. Everyone gets rich(the fault of insurance companies and lobbying groups), except for those needing the care. To make matters worse, because we lose so many young doctors’ to specialties, sub specialties and in many cases, sub sub specialities we then see a massive deficit in general practice (your family doctor).
As a result, Universities have (again, I have no empirical evidence, only what I see with my own eyes- albeit at the top hospitals in the country) stopped teaching practical family medicine and that has lead to even family doctors not doing even the most basic procedures. As evidence, we have seen a massive rise in 911 calls within the hospital. And I’m not talking about community urgent care centers, I’m talking about world renowned pediatric and adult trauma centers. Perhaps that is a result of tort laws, malpractice is ridiculous these days (though, I have seen a lot of things that would be ripe for malpractice) and that doctors would rather shift the risk onto another provider (ie: the paramedics).
When I was in Africa, my family doctor did everything from check-ups to stitches to minor surgery. Could a specialist have done it better? Perhaps, but it would have cost me a lot more, would have wasted his or her specialties and resources on a non-complicated case and someone else who needed those recourses more than me would have gone without. Of course someone will always go without, such is the nature of economics but I would have been the least efficient option.
So, what steps in the way of lowering prices,? Well, insurance companies and lobbying groups. Sub Specialists went into the field to make money and they’ll be damned if someone tries to stop that. Nurses (one of the fiercest lobbying groups out there- yeah, who would have thought it) prevent their wages from fluctuating and more importantly stop others from moving into the market, like Paramedics (Here, I am biased, I am a paramedic.) A lot of places have been wanting to push a Paramedic to Physician Assistant bridge program, this would basically allow “doctors” (PA-C) to make house calls in an ambulance. The result, less ER resources are used, less use for nurses and doctors, more pay for paramedics (but still a massive cut when compared to the cut in ER staff). Also to be considered is that the vast majority of Paramedics, don’t want to be PA-Cs’ but many do. So when the total is tallied, ER costs ( each patient visiting the ER can expect at least a few thousand dollar bill) are way down, nurses move to other departments (avoiding losing their jobs), some Paramedics get paid more and patients save in time and costs.
Tags: Doctors, Health-Care Economics, Healthcare Policy, Malpractice, Nurses, Paramedics
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