Friday, November 13, 2009

Image isn't everything

After months of contentious wrangling, the House has passed its version of healthcare reform. But to me, and many other observers, healthcare reform has largely become insurance reform. Why concentrate on slowing spending and controlling costs, those issues carry huge political risks. Insurance companies are easy targets. They have high-paid CEOs and they deny people with pre-existing conditions coverage, among other evils. Not surprisingly, polling data suggest that laying blame on insurance companies is safe ground for pols seeking to take a stand on reform.
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In all fairness, the bill contains a variety of changes that focus on quality and health system performance improvements. These include proposals that encourage the development of more primary care providers.
Can that provision get any traction?

Adding more docs isn’t as sexy as bemoaning the fact that millions don’t have healthcare coverage, or those pushed into bankruptcy because medical bills. But anyone seriously concerned about enhancing the health of Americans should pay special attention to this part of the bill. Do the math. How can we cover millions more without adding more docs?

Fact: As few as 2 percent of medical students are pursuing general internal medicine, a trend that could doom efforts at universal health care. According to an article in the New York Times, this death spiral in primary care is due largely to a poor image students have about primary care. But image isn’t everything, money matters too.

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