Assume for a moment that we pass single-payer, truly America-wide universal health care in the USA. This means that all of the currently uninsured will suddenly become effectively insured, and thus be able to be treated. Which will increase the total amount of health care provided in America.
If we have enough personnel to provide it, that is! I don’t see any underemployed physicians and skilled nurses and technicians hanging around doing nothing. So I don’t think we have an oversupply of these currently, so any truly universal plan would have to take into account the training of massive amounts of medical personnel.
Would the current medical training capacity be enough to train the new physicians and other personnel that would be required under the greater demand for medical services? Or would we have to open – and accredit – new schools for this purpose? Would we even be able to accredit new schools in time to get qualified personnel in the pipeline in time to provide the care that all Americans need?
I forsee this as being even more important than who pays whom for what, because if the supply is simply not there it doesn’t matter how much you are willing to pay for it (if it takes a fixed amount of lead time, around 6 years or so if not more, to provide the supply.)
Our medical schools restrict students from medicine. A kid I play rackeball with waited for over a year to get in. He was rejected the first time and he graduated college with a high GPA. His dad is a dentist. He thought the first year was tough. the second a lot easier.
Most people don’t go to a doctor for fun. I have insurance, and I can’t remember the last time I went to one. Sure, there will be people who will get the treatment they need; but I don’t think demand will outstrip supply. If it does, it solves another problem: unemployment. If more nurses are needed, then there will be people who will fill the positions.
Do we have an oversupply of nurses? It depends on who you ask. Some nurses find it very difficult to find a position. A friend has been a nurse for over a dozen years, and nobody in Seattle was hiring. Roomie has been a nurse for one year. She got a position at a rehab place. But they were quite understaffed and it was easy to get a job there. With UHC, I suspect that the places that are understaffed would be more willing to hire more nurses.
I know the OP ask specifically about doctors, but many people don’t need doctors to treat them.
From statistics that I’ve seen, the US has an equivalent number of doctors, nurses, and hospital beds per capita as any other modern nation. Since those other nations do have universal health care, and seem to be handling it, yes, we factually have the manpower.
This makes sense since we do have universal health care already – every hospital has an emergency room, and there are free clinics everywhere. We just don’t have official universal health care. Not that the distinction matters greatly so far as most debates go.
There are nowhere near enough primary care providers for everyone who wants one right now, much less when everyone has insurance. The total number of doctors may be adequate right now, but not enough are going into primary care fields, partly because the pay is lousy compared to the amount of training and debt required. When I was in medical school we ran the numbers for a solo doctor in a primary care clinic estimating overhead costs etc and it came down to something like 40 patient’s per day for the doctor to take home $85k. Economies of scale can work to some extent with multiple providers under one roof, but in the end, you can still only spend about 10-15 minutes with each patient regardless. Not too many doctors want to work in that kind of environment for that kind of pay.
This is a simplified, naive and inaccurate description of our current health care system. There are millions of uninsured/uninsurable patients who do not have access to ANY health care outside of the ER where they are not getting the preventative or primary care expertise they require. I am trained to manage the stroke you had from uncontrolled hypertension, but I am not trained to manage your chronic hypertension to prevent that stroke in the first place.
I made no aspersion that ER is a good system, just that it employs a significant number of physicians – who would presumably be moved over from emergency medicine to preventative if our system changed. That would require retraining time, but we do have the physical manpower to swing into place quickly.
Your point that people are uninsured isn’t very meaningful. Personally, I would rather have unlimited, entirely free, highest quality health care than health insurance. That’s not practical of course, but that doesn’t mean that a good universal health care system relies on an insurance scheme. (Probably it will, but that’s just limiting your thinking to approach the question from that angle.)
doesn’t matter b/c it will never happen. Our “liberal, socialistic” President just passed the republicans sloppy seconds counteroffer from the 1994 debate.
Note that universal health care countries like Canada and England tend to have waiting lists for non-essential surgeries, for instance. So it might be a matter of doing more serious operations and letting the less essential stuff slide for a while.
You would need to compare the elective surgery count to the numbers of doctors in the nation to determine whether freeing up manpower from elective surgeries would be particularly meaningful.
I think an erroneous assumption the OP is making is that the first day UHC is instituted you will NOT see every potential patient in the US show up at a doctor’s office for a checkup. There are plenty of people with health coverage who delay and delay going to a doctor.
As opposed to our system, where for many people only immediately lifesaving procedures that an ER can handle are done and long term problems (including fatal ones) aren’t ever fixed. It’s not like we don’t already have rationing, and more of it than most countries would put up with.
I think the problem will not be a lack of training facilities, but a lack of people who want to give up that many years of income, work that hard and incur that much in loans to earn what they would under a UHC system.
As stated above, PC doctors are already lacking, and many more are starting to drop Medicare/caid patients because of the awful reimbursement rate.
Do we have any estimates of what the service compensation would be under UHC?
As for the OP, if you take any large system, like the US health care system and radically change its structure overnight, how could you not have a short term under-supply of some things and over-supply of other things?
I think we are on the same side here. I inferred from your earlier post that you felt the current system of “universal” healthcare (ie “just go to the ER” as GWB said) is adequate which I think everyone agrees is not.
Your second point about retraining ER docs may be little shortsighted though. Every estimate I’ve seen anticipates increased ER volumes with more insured patients. We won’t be scaling back our staff anytime soon. Also I specifically chose do to ER medicine because I did not want to do primary care. I don’t think you are going to find too many emergency physicians willing or able to jump ship like that.
Which is why the ACA included several provisions to increase the number of Primary Care Doctors (primarily by paying them more and giving Med school aid to Med students dependant on their practicing Primary Care for X number of years).
UHC + not enough doctors = massive importation of foreign MDs. If you’re a forward-thinking patient you’ll learn another language (you don’t want to waste time explaining that no, you don’t need a prescription for hay fever, you’re having a baby. Your best bets are probably Hindi, Urdu and Chinese.