A few months ago, it seemed as if health care was the most important issue facing the country — unless you were more concerned with the constitutional crisis caused by the unitary executive, or possibly a needless war, erosion of civil liberties, the economic meltdown, and possibly a few other items. Anyway, health care did make it to the top twenty concerns, and that was pretty good under the circumstances. Lately, the economy, what’s left of it, has pushed everything else out of the way. It would have been nice to save the planet, but we’ve committed our resources to saving Freddie Mac and Fannie Mae. Energy independence seemed like a good idea, but it will have to wait until Lehman Brothers has settled down. Roads and bridges will just have to wait. And—maybe we can use this as a chance to look at healthcare more carefully, because we may have missed something.
The focus of healthcare reform has been on the affordability of insurance—providing some sort of financial coverage, private or government, to the 46 million people who have none. There have been a number of proposals offered, but they all focus on one thing: finding a way to pay for the goods and services. There’s another crisis that’s not getting anywhere near the attention it deserves—the personnel shortage, the lack of people to provide all those services that the insurance is supposed to pay for. For lots of reasons, we don’t have anywhere near the numbers of healthcare professionals that we need now, and will need in the near term. These are serious shortages, and the old solutions aren’t working.
The nursing shortage is the oldest and the worst. In 2002, Congress unanimously passed the Nurse Reinvestment Act which provides over $100 million in scholarships and other funding for people entering the nursing profession. In spite of this, there’s an estimate that by 2025, the United States will have a shortage of 500,000 nurses. The physician shortage should reach about 50,000 by 2020. There are about 12,000 audiologists in the United States, and as many as 50% are nearing retirement age, even as the aging population leads to an increased demand, and the number of college students entering the profession remains flat. Hospitals report that 21% of slots for pharmacists aren’t filled, even while projections call for a dramatic increase in need for pharmacists by 2020. In Washington, D.C., a shortage of mental health professionals is causing a serious problem because of people with severe problems going untreated. There aren’t enough dentists or podiatrists or physical or occupational therapists. There aren’t enough lab technicians and radiology techs are in short supply.
The easy stuff has already been done. Every profession has a para-profession from physician’s assistant to nurse’s aide. Task shifting is already in place, with questionable results: Nurse Practitioners are providing primary care which reduces some of the strain on physicians, but takes nurses out of the available pool. Pharmacists are administering routine vaccinations — which is another shift between shortage areas.
Staff shortages have driven salaries up, but increased salaries have led to demands for greater productivity and less scheduling flexibility, which reduces job satisfaction, leading more people to drop out of practice sooner or to find non-traditional areas of practice which adds to the shortages. Meanwhile, efforts to curb rising health care costs have focused on holding down reimbursement rates. When Massachusetts included dental care to their Medicaid program, the state found that there simply weren’t enough dentists willing to take on the additional patient load. The government can cut reimbursement rates, but it’s not really a buyer’s market. There’s still a market for hair transplants and breast implants, with no hassles and prompt payment.
This is basic supply and demand. Even if the money is there to pay for services, it won’t help if there’s nobody who can do the work.
Our attention has been drawn from healthcare to finance. No matter who gets elected, it’s likely that this is where things will stay for the next year or so. It might be a good idea to work out the details of recruiting more nurses and dentists, because without them, all those new, affordable health insurance plans will be worth about as much as the deed to a Florida condo.
Sam Uretsky is a writer and pharmacist living on Long Island, N.Y.
From The Progressive Populist, October 15, 2008
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