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So I was looking up Jonathan Gruber. He is a professor of economics at MIT. He was a key architect in Romneycare and helped in crafting Obamacare. So if anyone should know about the law, it would be him. He's not a partisan (although he is an idealogue). He has a book here: http://www.amazon.com/Health-Care-Reform-Necessary-Works/dp/0809053977/ref=sr_1_1?ie=UTF8&qid=1400374470&sr=8-1&keywords=Jonathan gruber
So anyways, I watched his lecture which is quite interesting if you have the time to watch, but one segment really came out at me when it came to the question segment of the talk.
Go http://magazine.wustl.edu/2013/december/Pages/Understanding-the-Affordable-Care-Act.aspx, click on the streaming video and then click to 43:00
Question from a physician:
"There's one piece that I think is missing in the dialogue, which is, what about the providers, bc we are caught in a very delicate situation. Insurance companies don't want to give us anything. The medical device companies and pharmaceuticals are increasing their costs for the care we provide for our patients, and so we are caught smack in the middle of this, not being able to provide care for our patients, and it hasn't played out entirely, but do you agree there is a big problem there?"
So several things, when Gruber answers:
1) Instead of actually answering the physician's question directly about the costs of pharmaceuticals/medical devices and getting those under control, he diverts instead into an interspecialty salary catfight, which as you can guess he chose the examples of Family Medicine vs. Dermatology (not shocked) in which he believes the solution is for the IPAB (a govt. body) to lower reimbursement in order to "depoliticize" the process
, bc he believes that in America we have overspecialization (not bc he cares about actual patient care, but likely bc of cost). On a tangent, he believes someone with medical school level debt should be happy with $150K-$200K working 60 hrs. a week, on call every other weekend. I'd like to take a guess what his hours and salary are. It's not as if doctors pocket the entire reimbursement from insurance companies. Meanwhile he: http://abcnews.go.com/blogs/politics/2010/01/on-jonathan-gruber-and-disclosure/
2) He also says this: "We need to change the way we deliver primary care in America. We need to have doctors do less, and physicians assistants and nurse practioners do more." Which he then uses the example of dentists and the dental hygienists. "The doctor in the future needs to spend 1/3 of the day seeing patients, 1/3 of the day on the phone, and a 1/3 of the day answering email. That will allow us to provide much broader coverage and stretch our primary care resources further."
I think it's very telling that he believes those in primary care (General IM, General Pediatrics, and Family Medicine) should do LESS and be pretty much administrators who only do patient care activities 1/3 of their day. And the rest of the time be business administrators. The only problem is: 1) PA/NPs are staying away from primary care if they can also and 2) NPs are fighting for equal reimbursement as well (the first battle being opening up scope of practice, which they are currently getting) and want to practice independently.
As far as the college students at a prestigious (or prestigious level charging) university asking questions, I'll hold my tongue on that. I'll just say I think it's funny he pretty much has the full bloated support of these college students (many of whom are probably applying for medical school) since they can be on their parent's health insurance till age 26 and are most likely still supported by their parents esp. at an institution that charges a ridiculously high sticker price for just undergrad.
So anyways, I watched his lecture which is quite interesting if you have the time to watch, but one segment really came out at me when it came to the question segment of the talk.
Go http://magazine.wustl.edu/2013/december/Pages/Understanding-the-Affordable-Care-Act.aspx, click on the streaming video and then click to 43:00
Question from a physician:
"There's one piece that I think is missing in the dialogue, which is, what about the providers, bc we are caught in a very delicate situation. Insurance companies don't want to give us anything. The medical device companies and pharmaceuticals are increasing their costs for the care we provide for our patients, and so we are caught smack in the middle of this, not being able to provide care for our patients, and it hasn't played out entirely, but do you agree there is a big problem there?"
So several things, when Gruber answers:
1) Instead of actually answering the physician's question directly about the costs of pharmaceuticals/medical devices and getting those under control, he diverts instead into an interspecialty salary catfight, which as you can guess he chose the examples of Family Medicine vs. Dermatology (not shocked) in which he believes the solution is for the IPAB (a govt. body) to lower reimbursement in order to "depoliticize" the process
, bc he believes that in America we have overspecialization (not bc he cares about actual patient care, but likely bc of cost). On a tangent, he believes someone with medical school level debt should be happy with $150K-$200K working 60 hrs. a week, on call every other weekend. I'd like to take a guess what his hours and salary are. It's not as if doctors pocket the entire reimbursement from insurance companies. Meanwhile he: http://abcnews.go.com/blogs/politics/2010/01/on-jonathan-gruber-and-disclosure/2) He also says this: "We need to change the way we deliver primary care in America. We need to have doctors do less, and physicians assistants and nurse practioners do more." Which he then uses the example of dentists and the dental hygienists. "The doctor in the future needs to spend 1/3 of the day seeing patients, 1/3 of the day on the phone, and a 1/3 of the day answering email. That will allow us to provide much broader coverage and stretch our primary care resources further."
I think it's very telling that he believes those in primary care (General IM, General Pediatrics, and Family Medicine) should do LESS and be pretty much administrators who only do patient care activities 1/3 of their day. And the rest of the time be business administrators. The only problem is: 1) PA/NPs are staying away from primary care if they can also and 2) NPs are fighting for equal reimbursement as well (the first battle being opening up scope of practice, which they are currently getting) and want to practice independently.
As far as the college students at a prestigious (or prestigious level charging) university asking questions, I'll hold my tongue on that. I'll just say I think it's funny he pretty much has the full bloated support of these college students (many of whom are probably applying for medical school) since they can be on their parent's health insurance till age 26 and are most likely still supported by their parents esp. at an institution that charges a ridiculously high sticker price for just undergrad.
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