Saturday, March 6, 2010


One of the main problems with the health care takeover this administration is attempting is a shortage of doctors.  Adding 31 million people to the rolls will put quite a strain on our system, and we can't just retask, say, the plumbers union.  It takes more than a decade to make a doctor - longer for a specialist.  So why are they plunging willy-nilly into a system that is inadequite and unprepared?

Well, that opens up an interesting line of thought.  We can all agree that Washington is a nest of lawyers, right?  The democrat party, in particular is just chock full of legal eagles.  Yes, the republicans have lawyers in their ranks, too, but not to the level of the current democrat party.  

Have you ever been to one of those really successful law firms?  Maybe availed yourself of their services?  There are a few partners and junior partners, but the bulk of the office consists of legal assistants, clerks and paralegals.  Those are the people doing the work, researching and putting the case together.  The partners are there to present in court, meet with clients and give final approval.  It's a good formula, and it seems to work for them, aside from the fact that it is like a legal factory, pumping cases through as quickly as possible or dropping them altogether if they aren't profitable enough.

Unfortunately, the lawyers in Congress who are reshaping one-sixth of our economy through our health care system are doing it in their own image.  The problem is, the system that works so well for them just won't work for doctors.

There's really only one reason this system doesn't work for doctors, but boy, is it a doozy - lives literally hang in the balance.  To me, that's a pretty big reason.  If a paralegal cites the wrong case, people don't die.  Nurses and PAs are great at screening out and dealing with basic or minor cases, thus reducing the case load for the doctor, but their skills only go so far.  Vastly increasing the case load without increasing the doctor pool will force the use of nurses and PAs for cases beyond their training.  Casualties will be inevitable.

Perhaps if Nancy Pelosi and Harry Reid had listened to the doctors in Congress, they might have created  different bills.  (While they were at it, they should have had the doctors fix their tone deafness...)  Predictably, they went it alone - Nanny Pelosi knows best! 

Maybe I'm overthinking this, maybe not, but it certainly deserves debate.  Everyone is caught up in process and cost right now, but we need to look at the effects of this bill as well.  This is a very big point, and something that will be effecting us fairly quickly and very personally.  The reforms start to go into effect in 2014, so there would have to be incentives to persuade students to switch their majors, but even then, the reforms will be in full swing before those candidates become full-fledged doctors.

When you add in how many doctors may be retiring or quitting upon signing this legislation into law, that means trouble.

The odds are pretty good, too, that eventually they will want to cap earnings for doctors to keep down costs, so I can't imagine that would be a big incentive for future generations of doctors.  Nothing like holding someone's life in your hands for minimum wage. 

When do we get to cap the lawyer's salaries?  Oh, that's right - never.

So, while I don't mind having a paralegal take care of my basic legal needs, when I go to the doctor, I want to see a doctor.   I went to a gastroenterologist a few years ago and was seen by his PA.  He was a nice guy, and seemed quite capable, but my case was beyond his expertise and he told me as much.  I appreciated his candor, but ended up having to find a new doctor, because it was impossible to get in to see the doctor himself, either due to surgeries or a lack of available appointments - they kept trying to get me in to see the PA instead. 

Luckily, I was able to find another doctor who had a smaller practice and was able to see me himself.  As a matter of fact, I don't believe his office even employed a PA.   My ability to find a doctor who could cater to my needs will be a thing of the past if the health care reforms pass.  I know they keep insisting that "if you like your doctor, you can keep your doctor", but how in the world do they expect to stretch the depleted doctor pool to cover 31 million more people?

Which brings me back to my premise.  The system lawyers have developed has enabled them to spread their resources in a way that allows them maximum profitability and effectiveness.  But that system just won't work for the medical field, because medicine is about more than just profitability and effectiveness - it's about people's lives.  The lawyers in Congress need to start waking up to that reality.

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