Published CommPro.biz 2014.03.25

Congress Blocking Doctors

Last Friday (2014.03.21) was “Match Day.” On that day thousands of mostly young doctors opened an envelope that confirmed their acceptance into a residency program. In many cases it defines the path their medical career will take for the rest of their working life. In most cases they knew they were in and just awaited final confirmation. For some it was their first choice and this was the first year they had been down this path. For others, they settled for what they could get. Others were back for another try, having missed the cut in earlier years. Still others missed the cut this year and will have to wait for next year, or perhaps the next, or the next, often while staring at a massive student loan debt.

For a nation facing a massive physician shortage –100,000+/- by the end of this decade– this is insanity. The number of residency openings is controlled by the United States Congress. Why there should be a problem with supporting this vital aspect of our healthcare system escapes us. However, we are living under a nearly two decade old cap put in place by the Congress. Given those in that body who are focused on anything but serving the people of the United States, it’s not likely that we’ll see a change.

On the other hand there’s good news. The number of bright young people –split about evenly between men and women– who applied to medical schools and the number enrolled as first-year students hit record highs this year. Add to that a dramatic increase in young doctors choosing family medicine. Five years ago it was under 60% with more than four in ten opting for specialties. This year it’s over 66% with less than one in three aiming for the specialties. That indicates a growing awareness among young doctors that the team-based comprehensive care ACA encourages is where the future lies. Primary care doctors will head-off serious illness in the future, saving lives, improving the lives of their patients and reducing healthcare costs.

There’s a new day dawning; young people entering medicine see it. Beat illness to the draw, make prevention the goal. The old model, treat people after they get sick is on the way out. Paying doctors based on the number of patients they run through their practice is so over. Payment needs to be focused on outcomes, on the overall health of the patients under a doctor’s care. America spends more per patient than any country on this planet. Yet we rank among third world countries when it comes to outcomes. The ACA is a baby step in the right direction.

Our lawmakers need to do the job they were elected to do, to serve the interest of all the people of the United States. They can begin by opening up more residency slots for young doctors who have fought their way into medicine, and are ready to go to work.

The Essential Benefit

The Essential Benefit

We are puzzled by a decision retail giant Wal-Mart announced limiting access to its health insurance programs. Access to healthcare benefits is important to the individuals in our workforce and to society as a whole. Living without coverage is a nightmare experience. The number of Americans who find themselves without health insurance –about 50 million– is shocking.

Two groups dominate this segment of our neighbors.
    1) The young: They believe they are immune to serious illness. They often have health insurance available –and they could afford it– but they would rather spend their bucks on something else. For minor issues they visit tax and/or community supported clinics. They pay a few bucks for routine care, leaving the rest of the cost for their treatment to the taxpayers, or those who support these clinics through charitable gifts. If they become seriously ill they often end up with a crushing debt, or bankruptcy. In the end we all pay for it.

   2) The working poor: They are not eligible for Medicare, Medicaid, or any of the other government funded programs that provide healthcare benefits for roughly half of all Americans. They worry about their health and try to ignore problems until a condition is really serious. Then it costs a ton to treat, either through the emergency room, or hospitalization. They can’t pay and so the hospitals pass the costs on to all their other patients driving up the cost of healthcare. Once again, we all pay for it.

This is where Wal-Mart, etc. –who employ the young and the working poor– can make a huge difference. Nobody expects any of these companies to pick up the health insurance premiums for these folks, but what they can do is make it available at a fraction of the cost of healthcare coverage in the open market.

When the working poor go direct to the insurers they face premiums far beyond their ability to pay, often three or four times the cost of a group plan offered through an employer. The reason for that hinges foremost on the ability of a company with thousands of employees to negotiate favorable rates. Add to that the much higher costs insurers incur in administering individual policies. A part of this cost –group insurance administration– is borne by the companies. We would guess that’s one of the reasons behind the decision at Wal-Mart to exclude some of their employees.

A short-sighted decision in our view. Access to affordable healthcare insurance is vital; it’s the kind of benefit that stabilizes a workforce. Less employee turnover cuts retraining costs and makes for better customer service, the lifeblood of a retail company. Moreover, taking care of your employees in this fashion says a lot about an employer, it makes people loyal and more productive. Not having to worry about their family’s healthcare costs keeps them focused on their job.

And besides, it’s the right thing to do; Ethics 101.

W.T.”Bill” McKibben is a Buffalo based author. © 2011 GLG