Sam Uretsky

Insurance Doesn’t Solve Staffing Crisis

The prospects for the year 2020 should include a lot of Karaoke machines offering the words to “I Can See Clearly Now,” but that may have to wait for 2021. Hindsight is always so much more reliable than foresight. But 2020 is the year we finally emerge from the Bush financial crisis and find ourselves up to our necks in the Obama healthcare crisis.

There’s a lot of attention being paid to Nouriel Roubini, a professor of economics at New York University. Roubini correctly predicted the end of the housing bubble and the global financial crisis. Roubini wasn’t the only one to see what was happening, but he was one of the very few, and sadly, those very few didn’t include the people who caused the problem, or those charged with preventing it. If, during his reappointment hearings, some senator asks Fed Chairman Ben Bernanke why he didn’t take steps to prevent the meltdown, the proper answer might be “that’s not the way we do things around here.”

So, although the US may technically emerge from the recession in 2009, the aftermath will be long and unpleasant. Unemployment will remain high because people who, in the normal order of things, were expected to retire and make room for the next generation will try to keep working in the hope of replacing some of their lost savings. Trillions of dollars in 401(k) accounts that would have been spent on orthopedic shoes and tickets to Wilford Brimley movies is gone, and handing out $250 to Social Security recipients won’t replace the loss. The Fed rate cuts, needed to save the banking industry, make it impossible to accumulate money through savings interest. With FDIC-insured accounts paying 0.01%, the only hope of having money make money is to head back to the people who got us into this mess to begin with. But by 2020, the aging Boomers will start to drop out, and the unemployment rate will finally fall. That should give Generation X a few years to pay off their student loans, get their own children though college, and save for their own retirement.

And while all this is going on, we can prepare for the Obama Healthcare Crisis, which will come about because although it will have been accurately predicted, the people who could have done something about it, didn’t. The time to prevent the coming health meltdown was in years past, and will be another part of the Bush legacy, but Obama will be the one who could have made things a little bit better, and didn’t. In place of Professor Roubini, we’ll have Sen. Dick Durbin (D-Ill.) to respect as the prophet who saw this coming. Sen. Durbin proposed S 1512: “Nurse Training and Retention Act of 2009,” the latest effort to assure an adequate supply of nurses for the future. The bill has no co-sponsors.

Warnings of a coming shortage of health professionals have been around for years, but the problem hasn’t been acute enough to get attention. Warnings of a shortage of faculty in nursing, dental and pharmacy schools have also been published, but they too haven’t been a real problem — yet. We desperately need more nurses, and qualified students are applying to nursing schools, lured by the promise of steady jobs, but nursing schools are turning away close to 50,000 applicants a year because there aren’t enough professors. Dental schools have hundreds of unfilled faculty slots. Sixty-seven pharmacy schools report a total of 417 unfilled faculty positions. There are shortages of physicians and podiatrists too, but the reasons are slightly different. Still, without teachers we won’t have professionals, and that means longer delays for treatment, rationing and needless deaths.

The best we can hope for is to soften the crash. According to a report in Health Affairs, the average physician spends the equivalent of three weeks every year dealing with the administrative demands of medical insurers. The only figure for nurses deals with those employed by physicians in office practice, but that comes to 23 weeks a year. Pharmacists can count on spending 20% of their time, one day of every week, dealing with insurance companies. A universal, single-payer insurance plan won’t train the additional professionals that we need, but it would give those we have more time to deal with patients, not paperwork.

The Astroturfers warn us that health finance reform will lead to treatment delays, rationing and death. Maybe. But without more serious reform than we’re even willing to discuss, delays and rationing will be even worse — but that’s the next crisis, so why think about it now?

Sam Uretsky is a writer and pharmacist living on Long Island, N.Y.

From The Progressive Populist, October 1, 2009