Whatever adjustment the Senate and the House make on the health-care
bill, one thing will really change. Your doctors’ waiting room will
always be full. Both versions of the bill add probably 30 million
currently uninsured people. Thirty million currently without medical
insurance will find themselves with access to doctors. But, as
BusinessWeek points out, there may not be enough doctors to serve them.
Why is this? Physician training takes time: a minimum of four years
past college, then at least three years of residence. Furthermore, the
demographics of aging have already put the U.S. into the grip of a
nationawide doctor shortage for people demanding access.
Medical schools have announced that they’ll add 3,000 new slots for
first-time students by 2018, but here’s the real kicker. Congress has
capped residency programs–and medicare pays for those programs. The
bill has an amendment to cover another 15,000 residencies, but that’ll
cost another $1.5 billion. But because congress wants to keep costs
down, that cost may very well take a hit.
If you don’t have a primary care physician now, you’d better get
one. My friends at the University of Minnesota Medical School tell me
that physicians often stop adding to their patient load. They can’t
manage the traffic.
These massive adjustments will go through different pilot programs
and they’ll take time. I refer to a brilliant article by Atul Gawande,
a Harvard surgeon and policy guru here.
Gawande writes very intelligently about how pilot programs work, and he
compares them to the changing of agriculture programs at the turn of
the 19th century. In a previous post this past week, I wrote that
David Brooks says that Gawande was the most influential essayist of
2009. So educate yourself. His first book, Complications, is a spell-binder. His latest, The Checklist Manifesto, is just out.
Let’s see, former White House appointee, Harvard surgeon, policy
guru, MacArthur genius, and his writing out Gladwells Gladwell.
The facts and statistics are summarized in Physician, Clone Thyself. (BusinessWeek, December 28, 2009.)