My primary concerns with health care reform are 1) Availability of Providers, 2) Quality of Service, 3) Provider Compensation, 4) Funding Source, and 5) Proper Identification of Unnecessary Costs.
1) Availability of Providers
a) More people using the health care system will cause longer wait times
b) The fear of lower salaries may lead to fewer qualified applicants to medical school, and if salaries decrease, older doctors may retire sooner than planned
c) It takes 3 years after medical school to train a family practice doctor. Assuming that more medical students can be quickly convinced to pursue family practice, that's still a 3-year gap before a larger number of physicians are available, which is a long wait if the family doctor becomes a sort of "gatekeeper" for specialists, as has been discussed.
2) Quality of Service
a) Increased demand for doctors' time will result in shorter consultation time
b) Government involvement creates more documentation requirements that takes time away from patients and money away from practices (that could be spent on diagnostic tools)
c) If lawmakers (with no medical training) put policies in place that limit funding for tests and procedures, patients may not receive adequate diagnoses and care
3) Provider Compensation
a) Medical training is long (11+ years for undergrad, medical school, residency, and possibly fellowships) and expensive (most medical school graduates owe over $100,000)
b) Patients expect doctors to be intelligent and good problem solvers. Compensation should be adequate to recruit the best and brightest into the medial field.
c) Compensation for many specialties is significantly less than it should be, compared to others (Family medicine, internal medicine, OB/Gyn, etc.)
4) Funding Source
a) Our national debt is currently at levels where our lenders are questioning our ability to repay it
b) I believe that estimates for savings by converting to electronic medical records are heavily overestimated
c) Taxing one group for benefits another group will receive is illogical and unfair
5) Proper Identification of Unnecessary Costs
a) Tort reform is necessary and will have an immediate effect on the cost of seeing a provider (lower malpractice insurance premiums)
b) Excessive medical testing is often the result of attempting to avoid a malpractice lawsuit, rather than lining the doctor's pocket
c) Paperwork is a major overhead cost for medical practices. While documentation is necessary, some reduction would ease these costs.
d) Nurse practitioners and physician's assistance can fill in gaps, but doctors with full medical training must be required to supervise them in order to prevent errors leading to more costly treatment that could have been avoided
My suggestions:
- Tort reform
- Do not allow denial based on preexisting conditions, but allow "contracts" which would guarantee X number of years of coverage (like a cell phone contract). This would help prevent someone from buying insurance only when they needed it, then cancelling after receiving treatment.
- No "public option" run by government. We already have Medicaid and Medicare. These could be expanded to cover the current uninsured patients and have a "buy-in" option if you qualify by being self-employed or employed by a company that doesn't provide insurance.
- If there is a "public option", insurance should be mandatory for everyone. If we're having to pay for insurance for everyone, they need to have it. A lot of our tax money currently goes to funding non-profit hospitals, and that money should be diverted to government-funded insurance. There's no reason for us to have to pay for insurance for people who want it without paying for it, AND health care for people who couldn't be bothered to sign up.
- Raise Medicaid/Medicare compensation for providers in specialties where there is a shortage. Private insurance companies follow their rates.
- Raise taxes for all income levels to pay for increased costs. People should not receive "something for nothing", and a single group should not be responsible for something that will never benefit themselves.
