Wednesday, February 13, 2013

Things that probably should have been thought of beforehand


Governor Jerry Brown and the state of California have fully embraced the new federal health care law and are charging ahead with setting up the state-run, federally-regulated exchange by which Californians will be able to shop around for health care coverage.

One problem: we are or will be soon experiencing a severe doctor shortage.

From the L.A. Times:

As the state moves to expand healthcare coverage to millions of Californians under President Obama's healthcare law, it faces a major obstacle: There aren't enough doctors to treat a crush of newly insured patients.

Some lawmakers want to fill the gap by redefining who can provide healthcare.

They are working on proposals that would allow physician assistants to treat more patients and nurse practitioners to set up independent practices. Pharmacists and optometrists could act as primary care providers, diagnosing and managing some chronic illnesses, such as diabetes and high-blood pressure.

With an aging population which will need more medical care and aging doctors that are eyeing retirement plus a younger demographic, that though, will not require nearly as much health care, are still being dumped onto the rolls anyway, this doctor shortage should not have come as any big surprise but… here we are.

We'll let Capt. Obvious, state Sen. Ed Hernandez (D-West Covina) and, no doubt, a big ObamaCare supporter explain further:

"We're going to be mandating that every single person in this state have insurance," said state Sen. Ed Hernandez (D-West Covina), chairman of the Senate Health Committee and leader of the effort to expand professional boundaries. "What good is it if they are going to have a health insurance card but no access to doctors?"

Hernandez's proposed changes, which would dramatically shake up the medical establishment in California, have set off a turf war with physicians that could contribute to the success or failure of the federal Affordable Care Act in California.

Doctors say giving non-physicians more authority and autonomy could jeopardize patient safety. It could also drive up costs, because those workers, who have less medical education and training, tend to order more tests and prescribe more antibiotics, they said.

One of the intents of ObamaCare was to eliminate unnecessary and unneeded testing. Now you've got C.Y.A. testing for people potentially not qualified or not as qualified as physicians in performing an array of medical tasks, practices, tests and diagnoses they were not asked to do before. Congratulations on cutting down on all that unnecessary testing.

And you'll be pleased to know that this doctor shortage is regressive in nature, hitting the poorer parts of the state the hardest:

Currently, just 16 of California's 58 counties have the federal government's recommended supply of primary care physicians, with the Inland Empire and the San Joaquin Valley facing the worst shortages. In addition, nearly 30% of the state's doctors are nearing retirement age, the highest percentage in the nation, according to the Assn. of American Medical Colleges.

The article goes on to explain, however, that physicians assistants, nurse practitioners, pharmacists and optometrists agree they have more training than they are allowed to use and while this may be true, there is nothing that quantifies this number and of that number how many would be willing to accept liability for false diagnosis or a procedural screw-up? Hello, more testing. Hello, more lawsuits.

To be fair, we don't have much of a problem allowing some folks that work in this industry to be plussed-up so to speak in order to do health work they are not specifically licensed to do, currently. However, as the title of this article suggests, this is something that should have been gamed out, at least, notionally before they passed this monstrosity, ObamaCare.

As it stands, we will have a crush of aging patients overwhelming the state's healthcare system long before any substantive changes to existing laws can be made to add/change duties and responsibilities to health care workers to meet this increased demand.

And what if it all turns out to be a horrible idea? What if the hastily-passed legislation that is ill-conceived and poorly-executed (sound familiar?) puts people in health care providing situations when they have no business being there, not necessarily through any fault of their own while providing for, in effect, guinea pigs? It's Sacramento, after all, and we'd give that a better than even odds shot.

What you have then is a situation where the condition of our state's healthcare system goes from merely bad over the next five years as patients entering hospitals cross paths with exiting doctors that are retiring to that of an abject and completely irreversible and irredeemable disaster looming in the next 10-20 years.

* It is duly noted that the Time magazine documenting a doctor shortage is 10 years old.


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