Sunday, January 06, 2008

How This is Going to Happen

As the presidential primaries come into full swing, I figure that it's about time that I relay a prediction. This isn't going to be about who is going to win or lose. It's all about what the winner, whomever he (or she) may be will do. This is really more of a long term prediction, as I doubt all but one or two candidates have any intention of doing it. This of course means that it will take time for it to happen.

There is right now a raging debate about how much physicians are worth and which jobs should be the purview solely of physicians. The issues of scope and reimbursement seem to have intensified in the midst of a very related debate taking place in the halls of Washington regarding the role of government in the provision of healthcare. These are currently seperate issues, but I predict that by the end of the next presidential term, they won't be. You see, when people debate these issues, the one thing that NEVER gets questioned is the fact that government has become ENTIRELY in charge of all of these points. Physicians, the market, patients, even the nursing unions and the hospitals that probably stand to gain the most from some sort of healthcare socialization still have no independent say in the way that things happen outside of their influence on Washington.

For the government to be able to take over healthcare, a number of things will need to happen. There is already a move (Kennedy bill to restrict compounding pharmacies, FDA attempting to standardize all supplements in N. America in conjunction with healthcare giants such as Mexico) to standardize medical care. Cookbook medicine is becoming a reality, and it doesn't take a genius to notice that critical thinking is already beginning to become more rare in a culture where every new idea is a potential lawsuit and strict reimbursement standards make it progressively more difficult to actually get paid for doing anything that Medicare deems unnecessary. This standardization will continue.

The next logical conclusion to jump to is that it doesn't require MD training to administer cookbook medicine. In fact, that training is almost a liability in the current environment. People in high places understand that there will come a point where reimbursement cuts will make becoming a physician financially unsound (though regardless of what many of us may think, this hasn't happened yet). The process is too arduous and expensvie to continue within the environment of declining reimbursement. As it is, physician training in this country is often akin to giving everyone a porcshe to drive through a school zone. Many of use are entirely over trained for what we do. The distinction of which training is necessary to what however, can't be decided by a committee.

Physicians have a nasty habit of going independent. They even opposed to the creation of Medicare and are one of the first groups who adamantly opposed free government money in the 20th century. None of us are naive enough at this point to believe that this remotely approaches majority opinion amongst physicians today. However, that independent streak occasionally pokes out. In the US today, there are a number of competing groups who are pushing for independent practice who have a history that is much more amenable to being told what to do. They have a lot to gain by giving in to any new initiative proposed (most of which they never really opposed at all). Enter the midlevel. The nursing unions already call any member who opposes ANY piece of legislation to extend healthcare entitlement immoral. That is a demographic that almost has to continually give power to the politicians in order to survive, thanks to a position that is held in large part by restricting training competition and keeping organized labor in an environment where physicians are not allowed to do so.

Now, I'm going to stop here and point out that I am NOT opposed to midlevels. I think that people should have the right to hire whoever they want to perform their services. If someone wants a midlevel PCP, that is their perogative. However, the one thing that seems to be true is that in this current climate, the patient will have NO say. While I generally support midlevels, I generally oppose misrepresentation. I believe that there is a definite attempt by some (not most) to overrepresent the training of midlevels, and I believe that this will be just a little too good to pass up on the part of officials in Washington looking to buy votes without devaluing the currency too much more than they already have.

You see, the current system is sort of like everyone being forced to buy a BMW or go without driving. The prices are high, and they are rising. The government wants to promise everyone a BMW, but the price is just a little too high. I think that the plan is to eventually buy a bunch of Fords covered with BMW symbols. No one is suggesting that we just have an open market in which some people have BMWs, some people have Fords, but almost everyone can afford to drive.

So this is my prediction. Obama, Clinton, Huckabee, Romney, or Guliani. Everyone has the same agenda, though that agenda is admittedly presented in a different way by each of them. Healthcare access for all will inevitably become healthcare provided for free either for all or for those who can't afford it (which is an ever growing piece of the population in the over-regulated healthcare environment) by the government. The hospital systems are becoming more monopolized and well connected. They will continue to get richer, because they don't really care about medicine itself. Physicians will either cave and become progressively more enslaved to the system, or they will be systematically removed from more and more of their responsibility regardless of what the patients want. The powerful nursing lobbies will continue to become more powerful, and the ARNP and the PA will take over a progressively larger role in healthcare. The ARNP will remain more powerful than the PA. The paycuts will continue, and the solution will be cheaper labor, not paying people what they're worth. It will continue to become more difficult to practice independently. It will all take time, but I suspect the agenda (which seems fragmented now) will become a lot more clear over the next 4 years.

Sorry for the negative vibes.

8 Comments:

Blogger Matthew said...

This comment has been removed by the author.

6:49 PM  
Blogger financephysician said...

great post, I know its tough to figure out exactly who anyone should vote for but it seems like the republicans themselves have similar policies that has a big focus on conservative issues like tax cuts, pushing and supporting free enterprise, limiting corporate taxation, etc. while democrats are focused on trying to provide tax benefits to the lower working class and promises of more services vs. tax cuts. its so interesting because I wrote a short article about this as well.

2:37 PM  
Blogger Mr said...

This comment has been removed by the author.

9:15 AM  
Anonymous Member 870 said...

If your predictions come true, should I enter medical school this fall, with my B.S. in Biology, or should I retool and become a plumber?

3:30 PM  
Blogger ObGynThoughts said...

member870, if you plan to live well, become a plumber...

Well, there is another alternative, and one that can help us navigate between the Scylla of single payer government bureaucracy and Charybdis of HMO bureaucracy. That alternative is to opt out of insurance plans and Medicare and go back to the roots. Patient and Physician, that's it, no third parties. In on esingle stroke this eliminates 90% of the administrative hassles, hassles of hunting payment, of fulfilling uncesessary requirement for this that and the other...
Third party free medicine is the answer and it is market medicine.

10:32 AM  
Anonymous Zara said...

Well said.

1:45 PM  
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