Because of ObamaCare, Medical School Must Be Free
One of ObamaCare's biggest shortcomings is its failure to take into account how a dramatic increase in the demand of health care while the supply of health care remains constant in the short term, will affect the quality and quantity of care available. In the long term, as demand continues to rise, supply of doctors is likely to fall because the enormous costs of training to become a doctor (not to mention the costs of medical malpractice insurance) outweigh the benefits of working for a progressively state run system in which a panel of so-called experts decides if and how much a doctor will be reimbursed for services rendered.
Becoming a doctor in the age of ObamaCare could not be less attractive. But this isn't an indictment of ObamaCare, explain Drs. Bach and Kocher in the pages of today's New York Times. Rather, it's occasion to start thinking about making medical school free.
...[T]he American Academy of Family Physicians has estimated a shortfall of 40,000 primary care doctors by 2020. Given the years it takes to train a doctor, we need to start now.
Making medical school free would relieve doctors of the burden of student debt and gradually shift the work force away from specialties and toward primary care. It would also attract college graduates who are discouraged from going to medical school by the costly tuition.
We estimate that we can make medical school free for roughly $2.5 billion per year — about one-thousandth of what we spend on health care in the United States each year. What’s more, we can offset most if not all of the cost of medical school without the government’s help by charging doctors for specialty training.
Although Drs. Bach and Kocher correctly identify America's looming deficit of physicians, their solution -- expand government involvement in order to solve the problems caused by government in the first place -- seems wrongheaded and naive. Furthermore, to assume that a talented pool of prospective physicians will willingly rush into a system whereby they'll still have to train for the better part of a decade only to become subject to the whims of Uncle Sam's panel of experts, is to assume that doctors are cut from a different cloth than are other professionals, and that they are less rational and less responsive to incentives.
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May '10
Re: Because of ObamaCare, Medical School Must Be Free
Ah the circle finally closes on itself, and the serpent bites its own tail.
The government's Ouroboros will now be complete, fat, sated, and self congratulating. The first fruits of quantitative easing are borne afresh.
Surely you cannot suggest that taxes should not be raised to fund the desperately needed free medical schools, and the tragically underfunded free law schools that are needed to sue them for malpractice? The free accountant training academies to administer and audit them, the...... Naturally they will need to be heavily unionised to work.
I am sure the Chinese won't mind providing the loans to facilitate more doctors to further socialised care for obese Americans. Perhaps the Chinese also have some spare bare-foot doctors laying around somewhere to help.
http://en.wikipedia.org/wiki/Barefoot_doctor
Edited on May 29, 2011 at 9:19pmDec '10
Re: Because of ObamaCare, Medical School Must Be Free
I think they're wildly underestimating the doctor shortage. I read a stat some time ago that over half of doctors are over 55 years of age. The docs in my family who are past retirement age would love to keep working, but they're not going to be told how to diagnose and treat their patients by the [expletive deleted] State.
On the other hand, my beloved nephew who finished his residency last year and entered practice is on board with Obamacare and fewer specialized doctors. He could have had any specialty and chose family practice as a matter of conscience and lifestyle. The only "conservative" argument he can make against Obamacare is, all experience and evidence with socialized medicine to the contrary, the emphasis on prevention may cause the panels to mandate colonoscopies for people who don't want them, thus depriving them of their free choice.
I'm guessing, given he has a couple hundred thousand in medical school debt, he'd be very supportive of the authors' suggestion. Which means we'll be needing more education camps... I mean free medical schools, of course, for all those doctors we'll be needing.
We are doomed.
May '11
Re: Because of ObamaCare, Medical School Must Be Free
For those who endorse the movement towards a government administered health care system, providing financing for physicians seems a natural step. It overcomes some of the negative financial aspects of what is to come. High debt load and limited compensation and, creates a constituency for greater government involvement. The next best thing to government [NHS] doctors.
May '11
Re: Because of ObamaCare, Medical School Must Be Free
The kicker is, of course, that government financed 'free medical school' is not actually free. We're paying for it.
May '10
Re: Because of ObamaCare, Medical School Must Be Free
Unfortunately, the quality of medical education will also decline. For prospective doctors, they will get what they pay for. On the flip side, American patients will pay for it...twice! Up front (as pointed out by Dan IV), and then in the hospital with undertrained attendees...
Jun '10
Re: Because of ObamaCare, Medical School Must Be Free
Welcome to Canada, folks!
May '10
Re: Because of ObamaCare, Medical School Must Be Free
You have it all wrong. We don't need doctors anymore. We only need people capable of following instructions. Surgery by numbers! Let's just hope the diagrams aren't made in China.
Jun '10
Re: Because of ObamaCare, Medical School Must Be Free
Here's the next political move to watch for: Doctors are told that there are too many practitioners in Houston and too few in Bumwash, New Mexico, so you now have to spend five years in Bumwash to pay for your medical education.
Apr '11
Re: Because of ObamaCare, Medical School Must Be Free
Gee, I sure hope some aspiring law student doesn't figure he is being discriminated against and figure his tuition should be free as well. This country needs lawyers too. Why should Physicians get preferred status?
Jun '10
Re: Because of ObamaCare, Medical School Must Be Free
In British Columbia a patient visit earns a GP $27.90 approximately (it may be a few pennies more or less) per visit. Procedures, such as draining an abscess or removing stitches, earn the GP approximately $15 plus the patient visit fee. In past there had been scandals involving GP's billing in excess of 100 patient visits per day as a result of visits such as prescription renewals, so there is now a limit of approximately 50 patient visits per day. This is also why most GP's in the province will not renew a scrips over the telephone—they cannot bill the call. The limit is set by what attracts auditor attention and not by fiat. The reason the GP is paid more for procedures is to encourage the doctor to do the procedure in his office, otherwise the patient would have the procedure done in the emergency room at a local hospital making it much more expensive to the system. As it is, emergency rooms are chronically overcrowded with nurses performing triage while patients wait. As for GP's, most clear their patient rosters of the chronically ill in favour of the chronically healthy.
Jun '10
Re: Because of ObamaCare, Medical School Must Be Free
There is no limit for British Columbia doctors when it comes to treating Insurance Corporation of British Columbia (ICBC) and Workmen's Compensation Board (WCB) claims. ICBC is the public automobile insurance company and the sole vendor of comprehensive automobile insurance in the province while WCB is the government agency that insures workers against injury in the province. Both agencies are government monopolies. Canadians like to believe that the Canadian medical system is not a two tiered system and that everyone gets equal treatment. This is false, because WCB and ICBC patients are treated first and fastest. Also, professional teams, such as The Vancouver Canucks, who can buy a doctor's attention, get it in spades. Most GP's also charge hefty fees for filling out forms, such as those required by ICBC and WCB, because of the time required to do the work, my doctor friends, almost to a man, would prefer not to get involved with this administrative work.
Edited on May 29, 2011 at 9:57pmMay '10
Re: Because of ObamaCare, Medical School Must Be Free
The whole medical school business is something I can't wrap my head around. Medical schools are always full and turning away applicants. If production is at capacity, with paying customers trying to get in, why must it become free? If money were made available, might it not be better aimed at increasing production? Starting a new medical school is costly, but should efforts perhaps be made to separate the research medical schools from others that could be designed to produce well trained practitioners?
In terms of cost controls, I suspect that the big bet of single payer advocates is that the bargain of limiting debt and simultaneously limiting potential income will not affect supply and that medicine will be the 21st century vocation, much like the clergy. I am not convinced.
Jun '10
Re: Because of ObamaCare, Medical School Must Be Free
What has all this got to do with the education of doctors? Simple, because of this limited earning capacity doctors migrate away from general practice. They either become specialists or end up specializing in botox treatments, baby wellness clinics (most babies grow up healthy without this attention), or hair transplant clinics, to name but three areas of practice. The result is a shortage of doctors, because no matter how many you educate they do not all stay in the "profession" as GP's, or if they do they cut back on hours of practice, or they limit their patients by type. In Canada this has resulted in massive over-crowding of emergency rooms and long waits to see doctors. Most hospitals in this area now have Hospitalists on staff. A Hospitalist is a doctor that looks after patients admitted to hospital that don't have a family-doctor to address their interests.
Nov '10
Re: Because of ObamaCare, Medical School Must Be Free
But right now, thanks to the government's intervention in the market in the form of student loans, medical school tuition is wildly inflated. It is not at all uncommon for someone to finish residency right now with a quarter of a million dollars in student loan debt--I have a junior colleague in exactly that situation. And if that's the case with people finishing residency right now, then the ones who are in medical school right now will be in even worse shape.
The people who benefit from this situation are the basic science faculty and the administrators.
Nov '10
Re: Because of ObamaCare, Medical School Must Be Free
This actually has been going on for at least a couple of decades. There are public health programs you can go into that will pay some tuition support in exchange for your working in an "underserved" area. There was a TV show, Northern Exposure, based on this fact. Also, many people go into the military to get their medical school tuition paid for. It is a good deal if you're eligible and don't mind losing control of your life for a period of four years or so after medical school.
Nov '10
Re: Because of ObamaCare, Medical School Must Be Free
I'm sorry to say that our situation in the US is not that different from yours in Canada. Medicare sets a price for a thing, and then all the private insurers negotiate rates that are based around the Medicare price. Medicare sets up billing codes, both for services and for diagnoses, and the private insurers use them.
The one way out I have heard of is what is called "concierge" practices; both of my parents have recently found their ways into such practices. One bypasses Medicare altogether and pays the doctor a set fee per year for all the care one needs. Medicare has set up rules that doctors who take Medicare can't take any money outside of Medicare for Medicare patients, so the concierge practice cannot take any Medicare money. Market forces allow primary care doctors this way to make a decent living.
Apr '11
Re: Because of ObamaCare, Medical School Must Be Free
I am a retired physician. While law schools have become a growth industry in many states the opposite has been true with medical schools. There aren't new schools or increased enrollment in established schools.
It is expensive to train a physician. To solidify the training one has to see real patients and make real decisions. Prior to the extensive rule changes in medicare over the years, a doctor in training (resident physician) could make patient decisions. Now most decisions require staff supervision thus doubling the effort with Medicare patients. Medicare has never considered the training of physicians. It takes more than a classroom!
Aug '10
Re: Because of ObamaCare, Medical School Must Be Free
Actually everyone knows that Canadians have a two tiered system - regular care and medical tourism. Now you are telling me that there are 3 tiers in the system.
The Brits have a 3-Tiered system Private for the wealthiest, tourism for the wealthier, and NHS (which is now in the habit of starving/ dehydrating patients).
Re: Because of ObamaCare, Medical School Must Be Free
The 'solution' here is almost a parody. Unbelievable - the left's appetite for government can never be satisfied.