Even MacGyver had limits. MacGyver was the name of the television hero, wonderfully played by Richard Dean Anderson, who could deal with any situation armed with his wits, a Swiss Army knife and whatever happened to be lying around. Lock MacGyver in a kitchen and he’d blast his way out with the ingredients of a chocolate souffle, then escape on a rocket sled powered by Diet Coke and Mentos. But you can just take it so far. You can make a slingshot out of a twig and a rubber band, but don’t try to start with a rubber tree and make the rubber band yourself.
And that’s the problem we’re facing today in health care. President Obama’s budget proposals are important, but the problem runs too deep, and for a while at least, things will get worse before they get better. The $634 billion down payment on healthcare reform is a start. It’s clear that this essential reform is high on the list of priorities. The traditional figure of 46 million people without coverage has undoubtedly grown with the rounds of layoffs and bankruptcies, so that improvements in the system are needed more than ever.
But the anticipated expansion of health coverage can be expected to lead to problems similar to those seen in Massachusetts where a state program vastly expanded health coverage, and revealed a shortage of clinicians. When more people could afford to see a physician, the demand exceeded the supply, and waiting times grew. Practicing physicians increased their case load, but that’s not enough. With an aging population and an increasing number of people with the financial resources to seek medical care, we’ll need a dramatic increase in the number of health care professionals, not just physicians but nurses, dentists, physical and occupational therapists, technicians, podiatrists, pharmacists and more. Every one of these fields already has a shortage, and the shortages are projected to grow.
Fortunately, two things may help relieve this problem, and one of them is the recession itself. It’s likely that fewer talented high school seniors will aim for a career in investment banking or hedge fund management. Laurence Shatkin, author of 150 Recession-Proof Jobs has identified health care as the place to be for employment security right now. While the cost of a professional education may have kept some students away from careers that require long periods of training, President Obama’s proposed increases in student aid, the increases in Pell Grants, will help. They won’t help enough—$5,000 is nice, but private schools charge $30-40,000/year, and courses of training that can go as high as 8 years of college and professional school for Medicine and Dentistry. State schools are more affordable, but they can’t manage the student load. Also, both Medicare and private insurers are trying to reduce reimbursement rates for health care providers, which will make it that much harder to repay student loans.
And there’s the problem. Longer periods of training and higher tuition mean more debt for graduates. To pay off the student loans, graduates go into practice areas that pay better than careers in research or education—but this means fewer physicians, nurses, dentists and technologists available to train the next generation, the additional professionals desperately needed to meet current and anticipated needs.
The nursing shortage goes back decades, but in 2007, US nursing schools turned away over 20,000 qualified applicants because there aren’t enough teachers. The American Recovery and Reinvestment Act (HR 1) includes $200 million to be divided between the Nursing Workforce Development Programs (Title VIII of the Public Health Service Act) and the Health Professions Training Programs (Title VII). Some of this money will even go to schools for faculty retention, including helping repay loans.
Sen. Dick Durbin (D-Ill.) issued a statement saying “The funding for health professions and nursing training included in this legislation ensures that thousands of vacant healthcare positions across the country will be filled. More than that, it gives men and women the opportunity to secure meaningful, well-paying jobs where they will work everyday to help prevent illnesses and save lives.” But it may not be enough. Subject to final allocation, the money may make a difference in nursing, medicine and dentistry, but even there falls short of complete resolution. Of a total of $500 million allocated to health professionals, $300 million is intended to revitalize the National Health Service Corps (NHSC). The NHSC provides loan repayment, salary support, and scholarships for physicians and other providers who practice in underserved areas. This too is a critical need, both in inner cities and rural areas, but it’s a need distinct from the faculty shortage, and since its intent is to direct new graduates into clinical practice, may compete with the need for qualified teachers in the health professions.
Universal health coverage is important, so is greater access to education, but we still have to go back one more level and offer inducements for health professionals to pursue academic careers. You can find ways to do a lot of stuff, but no one has ever found a way to improvise a teacher.
Sam Uretsky is a writer and pharmacist living on Long Island, N.Y.
From The Progressive Populist, April 1, 2009
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