Sunday, April 13, 2008

Retirement Planning and Universal Health Care: A Medical Army

The Medical Army of Massachusetts

Mention the word conscription and shudders can be felt throughout the populace. Parents concerned about kids, kids being concerned about an accustomed life interrupted by forced service from some authority they know little and care less about to civil researchers who point to the unfairness of drafting someone, who they have determined will be from a largely underprivileged class, all mire the inherit value of citizenship and service.

But this isn’t about the drafting of soldiers into military duty and in the truest sense of the word, it might not even be conscription. What universal health care needs is way to ensure that it works. In country where capitalism is also a political force that cannot be denied, even if it leads us into recessionary times, it would be difficult to rebuff those kinds of headwinds.

One of the main roadblocks facing the success of the Massachusetts attempt at providing universal health care is the key link in any health plan: prevention. With so many people coming into the system, many of whom have not had adequate access to care, the current system is overwhelmed. These people come with problems and ailments that have not been treated, many of which have grown into full fledged maladies, preventable in many cases had they had access to care.

That is problem number one. Problem number two should not have come as a surprise to the authors of this legislation. There were not enough doctors at the general practice level to accommodate the throngs of new patients. The New York Times recently reported the “The situation may worsen as large numbers of general practitioners retire over the next decade. The incoming pool of doctors is predominantly female, and many are balancing child-rearing with part-time work. The supply is further stretched by the emergence of hospitalists — primary care physicians who practice solely in hospitals, where they can earn more and work regular hours.”

Politicians are leaning towards some sort of tuition relief for doctors. This group, many of who claim that they did not enter into the medical profession for the monetary reward, has borrowed over six figures to complete the required training. Eager to recoup those costs, medical school graduates gravitate toward specialty practices that pay better than general practice, often three times better.

But we are thinking about relieving the tuition costs of the wrong group. If physician assistants, nurses and social workers could be given a free ride through college and, if their field of studies requires, beyond, couldn’t we conscript them to provide into four years of service for the plans in their state? Wouldn’t it be a small price to pay for the promise of a debt free career after their term of service was complete?

Social workers could visit patients before they become patients, providing them with the initial visit and the help them navigate the system. They could determine the level of care they might need, which for the home bound might be as little as a phone call reminder once or twice a day from a nurse to take their medicines.

Nurses would be given regions of the state, lording over their districts in much the same way the school nurse might. This second wave of care would provide the comfort many illnesses need and because of their position in the system, they would assess whether a doctor would be needed or a physician assistant could make the diagnosis. Care would be given in small regional clinics, perhaps set-up as a storefront in a small town.

Regular wages would be paid to each of groups. Dropping out of the program would always be an option but your deferred tuition would be yours once again.

But what about doctors and their better-paid counterparts, the specialists, the folks who are in such short supply, who would rather work in a hospital setting? How would we get the most critical part of the system to help?

They would be given volunteer status in the program. How do you give them similar benefits without making them sign a contract for long-term service? You give them tax incentives. Each year a doctor serves as a general practitioner allows them to work tax-free. No income tax on the federal or state level. Nothing.

Once a patient has been assessed by a social worker, visited a nurse, been diagnosed by a physician assistant, the once a week visit to the clinic to see the patients who required a doctor’s care or the reference needed to see a specialist, would be almost negligible. He could charge them as he would any other patient under the plan but the income he generated from these visits would not come with a tax penalty.

The same could be offered to nurses, social workers, and physician assistants who chose to stay on after their four-year conscription was finished.

Of course there are just as many cons to this kind of health care solution. How do you weed out the bad ones who simply want a free ride to college? Make GPA’s earned in college the determining factor for admittance to the program.

How do rate the care given once these professionals begin their post-collegiate service? Exit polls of patients would be the simplest answer. The system would spawn a more motivated and engaged workforce, a sort of homespun medical Peace Corp, out in the field, doing work where work needs to be done.

Wouldn’t more populace states would be overrun with help while smaller, more rural states would be left wanting? There is always that but it has always been my impression that those rural states view their relative isolation as a way of life and not so much an obstacle. States could further sweeten the pot by providing free housing and transportation and do so with the hope that the medical worker might stay long-term.

Massachusetts could be the perfect place to test just such a program. They show great economic and often geographic diversity, often within a few miles of a major metropolitan area. No one said the plan would come off with some tweaking but the creativeness of how it should be done is often left in the hands of people too close to the original plan.


Bart McCollum said...

Thanks for your comments on Paul. this is an interesting and innovative idea for the staggering problem. Many states offer lawyers tuition assitance and student loan forgiveness if they spend a certain amount of time in public service...perhaps the model can be adapted to health care.


JaaJoe said...

Did you see the Bunk study stating 2/3 of doctors in America want National Health Care. The doctors who did this study also conducted one in 2002 and found that the majority of doctors did not want national health care, the problem with this is that the 2 question surveys drastically differ in there 2nd question. I found this article, 60% of Physicians Surveyed Oppose Switching to a National Health Care Plan, It's worth a read.