A pipe dream? Perhaps. It requires people to do what’s best for its citizenship, not just what is best for themselves. And it requires some serious, outside-the-box thinking.
Let’s deal first with physician care, something near and dear to my heart. We have already stated that there is a serious shortage of physicians. And this shortage is likely to worsen as the Baby Boomers continue to age; resulting in increased physician retirements and increased demand for services. But is there anything that can be done about this. What prevents us from simply training more physicians.
There are two major limitations. The first is that currently the medical establishment has limited the number of seats available to incoming first year students in American Medical Colleges. To the point that there are not enough graduates to fill available residency positions, forcing many hospitals to rely on foreign medical graduates to staff their facilities. The thinking has always been that by restricting the number of incoming students, it will be possible to guarantee that only the best and brightest are admitted.
Even more limiting is the expense of that education. In this country the average cost of a medical education is $207,866. This includes both private colleges and state-sponsored colleges. Compare this with just over nine thousand a year in the UK for five years of training, with a total cost of $45,000. The rest is underwritten by the government in return for their working for the National Health Service. They are, too a large extent, primary care providers who are paid a salary by the government and are protected from frivolous lawsuits, in much the same way as our physicians in this country are, who work for the military.
The government currently spends about 186 billion dollars per year on physician services alone while the cost of subsidizing the education of graduating medical students would be less than 850 million dollars a year. And for that investment, the cost of their services could be set by the government for those that chose to have their education paid for. There would still be those that wished to pay for their own education, which would place them in a position to share in greater rewards (by charging what they wanted and hopefully providing the services that some would want) and greater risks (being subject, as they now are, to the legal system). The beauty of this scenario, is that it allows current physicians to continue in a system that they have become accustomed to, while allowing future generations to “grow into” a National Health Service.
But for this to be successful, it requires that the legal system accept some measure of tort reform, and that the central government realize that by subsidizing medical education, in the long run, costs will come more under their control. A leap of faith, I must admit, but one deserving of serious consideration.
Also quotas would need to be established for the percentage of physician trainees that would go into primary care. While it might restrict the number of specialists trained as a result, at this time, the crushing need is for more primary care providers.
What about drug costs. Aren’t they becoming prohibitive for folks? Absolutely. But if we begin to develop a National Health Service, it will only make sense for the government to negotiate prices with pharmaceutical companies. This happens in every other industrialized nation. If you doubt that, you have no need to look further than to our neighbor to the north, Canada. While I was still in practice, it was not uncommon for me to become aware of my patients trying to buy their medications from across the border, risking legal action for breaking the law in order to comply with my treatment recommendations.
What about the costs of testing? If a National Health Service were implemented, with limited legal exposure, the need for duplicate testing would disappear, and only excessive testing done in clinically challenging cases would continue.
And hospitals? Well, it might require some changes in the services that they offer. It may be that the next generation of hospitals will only include an emergency room, an ICU, a surgical suite for major cases and, perhaps, a maternity ward. And with the plethora of physicians, home care and rehabilitation care will be more easily supervised in rehab centers and in the out-patient settings.
Would this work? You can talk to folks in other nations, who already have a universal system. Some of these are tiered. Some provide the same benefits to all their citizens. Most will say that their economy is still struggling under the burden of providing those benefits. But the costs are undoubtably lower than they are in this country. And all of their citizens get at least basic care when it is needed.
I would welcome any comments about these suggestions. It is only through dialogue that answers can be found. As I said at the beginning, if the solution were easy we would have one by now.