We've got to find more doctors, expert says
| Wednesday, Oct 28 2009 10:09 AM
Last Updated Wednesday, Oct 28 2009 10:09 AM
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My new e-mail pen pal is Dr. Arthur Caplan, professor of bioethics at the University of Pennsylvania, who spoke in Bakersfield Oct. 5. I'd read a couple of his articles on health care reform, including one that focused on the many things we as Americans can learn from peer nations like Japan and Switzerland, and I assumed he was a straight-down-the-line liberal on the subject.
Not so, as his 45-minute speech at Cal State Bakersfield (part of the Kegley Institute of Ethics' fall lecture series) and subsequent e-mails made clear.
One of his concerns in particular has validity no matter what Congress does with health care reform. Make no mistake, Congress will eventually do something to improve on the status quo, but even if plans for a major system overhaul were to die an unlikely death, the U.S. would still be forced to face up to its serious (and growing) shortage of physicians.
What, I asked Caplan in a post-speech e-mail, do we do about that? If and when millions of Americans become newly insured, we won't have enough doctors and nurses to handle them, because we don't even have enough to handle fully insured Americans today.
Caplan's plan: Put more new doctors and nurses in hospitals and clinics across the country by forgiving medical-school loans.
If current trends continue, Caplan explained, the shortage of primary care physicians will reach 40,000 in a little more than 10 years. Medical schools are only graduating about half the needed number of primary care doctors. The overall shortage of doctors may grow to 124,400 by 2025, according to a study by the Association of American Medical Colleges. Universal health coverage is likely to create shortages that are even more severe.
So, Caplan declared, forgive all medical school loans for any student willing to go into primary care and practice for a minimum of 20 years, and extend more authority to nurses, pharmacists, physician-assistants and other health care professionals to help fill in the primary care gap.
His idea makes sense. We do that sort of thing for engineers, physicists and many other science-and-technology specialists anyway, mostly in the form of university scholarships, so why not the experts who keep us healthy and alive?
I asked Caplan to more fully explain a few other points he raised In his address at CSUB.
Why is it so important for President Obama to declare that "health care is a right"? I reminded him that some people (conservatives mostly) maintain that health care coverage is not a right but a commodity much like anything you'd buy in the capitalist marketplace. Earthquake insurance. Wine-of-the-month club membership. Cable.
"They are wrong," Caplan responded, "because a nation committed to equality of opportunity must provide food, shelter and health care to a minimal degree to let its children, sick, disabled, elderly and frail compete and flourish.
"Do they really propose telling a 10-year-old with no dental care or a 25-year-old with depression and diabetes that health care is a privilege? They don't (completely deny care), and so these people wind up at the ER costing us all a fortune. Once you concede some care, then health care as a right is pretty obvious in developed nations."
What's holding up tort reform, and what is the best option if Congress actually agrees to make changes? Obama "has not taken this seriously enough," Caplan answered. "The trial lobby is holding him hostage. That is a legit criticism of his plan, and what he has said about reform so far, even including the sort of bone he threw Republicans at his 'you lie' speech, (is inadequate). Mandatory mediation prior to trial ... is the way to go, and since many lawyers support mediation, he might break through with that."
Why is the implementation of electronic medical records so vital? Some folks would say this is a privacy issue. "Their health depends on it," Caplan answered. "Gotta have it if they don't want to be killed by paper mistakes. Just put in real and severe penalties for violating privacy."
Back to the subject of loan forgiveness. Are any other nations doing that? Is there a model we can follow. His answers: No and no. This program would be a first. Other countries don't do it, but then "other countries don't pay their specialists a fortune more than their primary folks so they don't have this issue. Gotta alter compensation a bit and bring on the nurses and PAs and pharmacists."
Many critics of health care reform say universal care will lead to rationing. Does rationing really get worse after we insure everyone?
No, Caplan responded, it gets "better -- you don't keep a quarter of the population outside the system, which is the worst form of rationing."
Aside from his tort reform stance, those positions sound a lot like the ones we're hearing from the Democratic side of the aisle. But Caplan departs from traditionally liberal positions in two other areas. He demands that the U.S. adopt universal care for citizens only, excluding illegal immigrants (with exceptions that address the common good, such as treatment for infectious diseases).
He also prefers co-ops over the creation of a government option to private insurance. The U.S. already has effective models, he noted. "Group Health Cooperative is a consumer-governed, nonprofit health care system based in Seattle that is nice model for a co-op," Caplan pointed out. So we wouldn't be reinventing the health-care wheel.
But we'd be making some major modifications, no question. Caplan is convinced they'll be for the better -- if we do it right by vastly increasing the number of primary care physicians and nurses at our disposal.
E-mail Robert Price at rprice@bakersfield. com.
