Wednesday, February 18, 2015
A couple of worthy reads today.
The not always reliable but reasonably on target this time Matthew Yglesias offers four ways to improve health care in the U.S. and, oh yeah, actually save money at the same time. His first idea is to admit more foreign M.D.s to practice in the U.S. I do have a correction -- we don't have a shortage of doctors, we have a shortage of primary care physicians. If we're going to let more furriners in, they should be primary care docs. Right now, it's very difficult for non-U.S. citizens to get working papers, and to get licensed. We could make it easier. However, Yglesias's idea that they would work for lower salaries doesn't sound very viable. They'd have to get paid like everybody else.
He also recommends that more states allow Nurse Practitioners (and I would also say Physician Assistants) a wider scope of practice. They can do most of what primary docs do, they are paid less, and they are a lot less costly to train. We could expand the supply of primary care providers fast if we allowed more of these "physician extenders" to practice.
He also wants to change the patent rules so that drug companies don't get such extended monopolies, which would bring down prices. Actually his idea of awarding prizes for new drug development isn't that great -- we should have publicly funded drug development, which would allow us to aim the research at meeting public health needs, instead of profit. Then the government would license the new pharmaceuticals to manufacturers for a reasonable fee, requiring them to limit themselves to a reasonable profit.
Finally, he wants all-payer rate setting. It's a bit wonky, but it basically accomplishes some of the cost savings of a single payer system. It still leaves the insurance companies in the middle as useless parasites, but that's probably the best we can do.
Then there is Jonathan Chait, taking down a Heritage Foundation slam of Obamacare which consists entirely, from beginning to end, of outright falsehoods. Just read it.
Finally, in the NYT, Gina Kolata reports on efforts by physicians to remake medical practice with the end of reducing suffering. Surprise though! That doesn't mean palliative care, more pain killers, or massages. It means doctors not being jerks. The "suffering" in question is caused by treating people like shit, not bad biomedicine. Something indeed to think about.