California facing doctor drought in wake of U.S. health care reform

In Opinion

California has been preparing for drastic changes to our medical system since the approval of the Affordable Care Act, expected to launch in 2014.

But alongside the benefits, the state also faces the challenge of making the implementation work, and some experts worry that our already overpacked system may collapse. According to the Los Angeles Times, the California HealthCare Foundation (CHCF) has proposed possible solutions to address the concern of flooding the system, but, as in any democracy, not everyone agrees on what is going to work.

Among such topics is the redefining of who can provide health care, which would expand the field of primary healthcare physicians to include physician assistants, nurse practitioners, pharmacists and optometrists. This would allow relief to the underserved counties that lack physicians. The CHCF is also calling for incentives to relieve recent MD graduates of school finances by serving such counties for their first three years in residency.

Critics of these ideas insist that expanding primary physicianship will both endanger patient safety and increase costs. Under-experienced workers tend to “order more tests and prescribe more antibiotics.”

Put simply, these incentives will take years to create more coverage for depreciated counties—years that we don’t have.

Anyone who has visited an urgent care can testify that the total amount of time spent with the doctor is equivalent to the time it takes us to change one’s underwear. Most of the leg work is done by the nurses. I have seen plenty of physicians enter a patient’s room with a computer, arriving to a diagnosis after entering symptoms into their software.

I’m pretty sure this work can be extended to the professions previously listed above. It’s not like we are asking them to perform brain surgery.

According to a report from California Watch, implementation of the ACA may have unforeseen costs which unfortunately may come at the expense of our state’s children.

The report identifies a focus of concern toward a bill passed in November of 2012 that would abandon the California Healthy Families insurance program, which insures children whose family income is too high for Medicaid but too low for private insurance. The proposal was approved through the Brown administration as a budget cut to improve revenue by saving up to $72 million per year. The bill will affect 870,000 children currently enrolled in Medi-Cal.

That bill was to be effective in January 2013 but was delayed to March due to reports of possible physician abandonment. It is expected to be implemented in four phases, ending in August.

The current debate with Medi-Cal is whether or not most physicians will reject potential patients due to extremely low reimbursement rates—almost 50 percent less than Medicare. So healthcare providers will gladly accept older patients, who are covered by Medicare, over children who cannot possibly provide healthcare for themselves, all because they are guaranteed a paycheck? Unfortunate, but seemingly the case.

A report in November 2012 by Health Net, which currently covers 86,000 people under Healthy Families, gave notice to the state, stating “it can’t say how many of its doctors will continue to see children after they are moved from the better-paying Healthy Families program to Medi-Cal.”

Unfortunately, the constant bickering most conceivably boils down to loss of money. At its most obvious (insurance companies) to its most disappointing (the workforce), everyone is scared of taking a pay decrease that will benefit millions of Californians.

But it may not have to come to that.

A report released by the Institute of Medicine found that the U.S. health care system wastes $750 billion each year. ABC News reported that this money could have provided health insurance for 150 million Americans. Reports like these can help aid waste expenditure so the multi-trillion dollar health care system won’t lose a precious penny.

I’m sure the great thinkers of America can figure out a way to make this system—which already functions in most other developed nations—work. The future of health care in California might just depend on it.

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