President Obama: Don't Forget About Doctors
GUEST BLOGGER: Richard M. Scheffler
With President Obama heading to Capitol Hill this week to lay out his prescription for health care reform before a joint session of Congress, we asked guest blogger Richard M. Scheffler for his perspective. Scheffler is author of "Is There A Doctor In The House? Market Signals and Tomorrow's Supply of Doctors" (Stanford University Press, $27.95), which examines the economics of keeping the health care system sufficiently staffed with properly trained physicians. Scheffler is distinguished professor of health economics and public policy at the University of California, Berkeley.
President Obama's health reform speech next week may be his last chance to get it right.
Providing affordable health insurance for all is the focus of his plan to date, but without systemic improvements to our health care system, we will not get our money's worth or be able to foot the bill. The president must know this and he needs to tell us what he has in mind.
Any reform that covers more people will translate into pressure on the health care system. The system now under-provides basic primary care -- which is key to a well-functioning system. The health workforce needs to be reconfigured. We need more primary care doctors, nurse practitioners and physician assistants, and we need them right away. If we do not have an adequate number of primary care providers, then the reforms will surely fail.
Newly insured patients will not be able to access primary care services, because they will be competing in a market with provider shortages. They may use specialists instead, who are much more expensive and have less experience in many cases in delivering primary care services. Taking care of the whole patient, prevention and safeguarding the overall health of the patient is what it's all about.
So what can the richest nation in the world do about all this?
We can increase the funding for training primary care providers -- not just doctors, but nurses and other health workers as well. Make this part of the reform plan next week. In addition, the president can recognize that primary care providers are underpaid and do something about it. Primary care doctors make about 60 percent of what specialists do.
Most of this is due to low fees. Medicare, for example, has a fee schedule that makes this happen -- it heavily favors specialty care over primary care services. This needs to be changed and the president should tell us how he plans to do it.
Without these changes more will be spent but little will change. We need to pay for quality care, not just more specialty care.
Now is the moment. Leaving out health workforce reforms would be the Achilles heel of any health care reform plan.
By Steven E. Levingston |
September 4, 2009; 11:48 AM ET
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