Hint: Medicare For All would eliminate it and nobody seems to be talking about it.
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Anybody remember the Simpson-Bowles Report?
It was commissioned by President Obama shortly after he was first elected … reported out in 2010 … and trash-canned shortly thereafter … since it predictably recommended spending cuts and tax increases.
According to Simpson-Bowles, the “biggest“Federal tax break” is ….
They dropped a couple of doozies during last weeks debate…
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I went cool turkey (<= that’s not quite “cold turkey”, but pretty close) away from cable news while at the beach.
On return, I jumped off the wagon by watching parts of the Democratic debates.
I was expecting entertainment value … and I wasn’t disappointed.
Reminded me of the old Happy Days tv series that – among other things – coined the the phrase “jumping the shark”.
Ratings were slipping, so they had Fonzie (Henry Winkler) jump a shark while water skiing … hoping (but failing) to generate some ratings-boosting buzz.
So now, according to Wikipedia:
Jumping the shark is the moment when something that was once popular that no longer warrants the attention it previously received makes an attempt at publicity, which only serves to highlight its irrelevance..
How does that apply to the Dem debates?
Not really: it just covered more people with health insurance?
Since Dems are making ObamaCare an election issue, let’s flashback to a prior post and inject some facts…
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In my consulting / problem-solving class, I emphasize asking the right question before starting to gather data, doing analyses, drawing conclusions and making recommendations.
Makes sense, doesn’t it?
Then, would someone please explain to me why the politcos (on both sides) obsess over health insurance coverage (how many people are covered) and largely ignore the quantity & quality healthcare that Americans are getting?
Source: AAMC
My conclusion: More Americans now have health insurance, but healthcare hasn’t increased … it has just been re-distributed.
Grant med school grads provisional licenses.
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Very interesting idea reported by the Heritage Foundation …
It widely accepted that the U.S. has a current shortage of doctors that is expected to balloon as the demand increases (aging population, expanded Medicaid, etc.).
Current estimates put the 2030 shortage between 40,000 and 105,000.
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Each year, US med schools crank out about 18,000 medical degrees. Source
Dictated by the AMA, before getting licensed, these grads need to go through formal residency programs at teaching hospitals.
Here’s the rub.
The residency programs are largely government funded, and there are spending caps.
Spending caps translate to enrollment caps.
So, each year, about 5,000 of the med school grads — more than 25%) — don’t get a residency slot.
No residency, no license.
Reportedly, these non-residentially certified med school grads either land in non-patient treating medical jobs (think “pharma”) or leave healthcare all together.
The usual response: just throw more tax dollars at the problem.
But, there are other options…
Addressing the problem, a few states have implemented a program that Heritage is now touting: provisional licenses.
For a long time I’ve railed that politicos and pundits confuse “healthcare” with “health insurance” – trying to fix health insurance (by throwing money at it) … rather than getting to the efficacy and efficiency roots of healthcare delivery.
Here’s another twist to the story.
I stumbled on a report from the Kaiser Foundation: Beyond Health Care: The Role of Social Determinants.
It’s punch line:
“Though health care is essential to health, research demonstrates that it is a relatively weak health determinant.”
More specifically, Kaiser concludes that healthcare has only about a 10% impact on the risk of premature death … dwarfed by genetics (30%) and individual behavior (40%).
Said differently, health behaviors, such as smoking and diet and exercise, are the most important determinants of premature death
And, as the title of the article’s title suggest, there’s a social component (20%) that’s double the impact of healthcare per se …
… and how many medical degrees are granted each year?
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Let’s start with the last question first…
Currently, U.S. medical schools graduate almost 19,000 students each year.
Most healthcare pundits agree that – while the number has been increasing over recent years – too few are being graduated to forestall an anticipated doctor shortage.
![clip_image002[6]](https://kenhoma.files.wordpress.com/2017/08/clip_image0026.jpg "clip_image002[6]")
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Note that since 1960, there have been 3 distinct periods: growth from 1960 to 1982, flatline from 1982 and resumed growth from 2006.
Here’s a short history of medical school openings and admissions …
…. and, how old is the pool of active doctors?
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Even though Congress is punting on healthcare (or maybe because Congress is punting on healthcare), I decided to to get better informed on the topic.
Of course, I like to start with the numbers.
Where better to start, than with the “ 2016 Census of Actively Licensed Physicians in the United States”
Note: Unless noted to the contrary, all data reported below is from this census .
Today, let’s look at physician demographics ….
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An aging pool of doctors
The average age Active Licensed Physicians is just a bit over 50 years old.
Older doctors (over 60 years old) are the biggest age group … and their percentage of the overall mix has been increasing.
Bottom line: the pool of doctors is aging as baby boomer doctors “mature”.
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How do the numbers break out by gender?
… and how many got their degrees from U.S. schools?
========
Even though Congress is punting on healthcare (or maybe because Congress is punting on healthcare), I decided to to get better informed on the topic.
Of course, I like to start with the numbers.
Where better to start, than with the “ 2016 Census of Actively Licensed Physicians in the United States”
Note: Unless noted to the contrary, all data reported below is from this census.
Here are some of my takeaways ….
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There are about 950,000 active licensed physicians (ALPs) in the U.S.
Doing the arithmetic, that works out to about 350 people per doctor … or, reversing the stat, about 295 doctors per 100,000 of population.
The number of doctors per 100,000 of population is relative even across states, with one glaring exception … that might explain our crack Congress is content dragging their heels on real healthcare reform.
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Let’s dig a little deeper into the numbers ….
Not really: it just covered more people with health insurance?
=========
In my consulting / problem-solving class, I emphasize asking the right question before starting to gather data, doing analyses, drawing conclusions and making recommendations.
Makes sense, doesn’t it?
Then, would someone please explain to me why the politcos (on both sides) obsess over health insurance coverage (how many people are covered) and largely ignore the quantity & quality healthcare that Americans are getting?
Source: AAMC
My conclusion: More Americans now have health insurance, but healthcare hasn’t increased … it has just been re-distributed.
Grant med school grads provisional licenses.
========
Very interesting idea reported by the Heritage Foundation …
It widely accepted that the U.S. has a current shortage of doctors that is expected to balloon as the demand increases (aging population, expanded Medicaid, etc.).
Current estimates put the 2030 shortage between 40,000 and 105,000.
=========
Each year, US med schools crank out about 18,000 medical degrees. Source
Dictated by the AMA, before getting licensed, these grads need to go through formal residency programs at teaching hospitals.
Here’s the rub.
The residency programs are largely government funded, and there are spending caps.
Spending caps translate to enrollment caps.
So, each year, about 5,000 of the med school grads — more than 25%) — don’t get a residency slot.
No residency, no license.
Reportedly, these non-residentially certified med school grads either land in non-patient treating medical jobs (think “pharma”) or leave healthcare all together.
The usual response: just throw more tax dollars at the problem.
But, there are other options…
Addressing the problem, a few states have implemented a program that Heritage is now touting: provisional licenses.
Answer: Of course it did … it’s simple arithmetic.
==========
In yesterday’s post, I concluded that ObamaCare increased the demand for healthcare by providing health insurance to 20 million previously uninsured Americans … but that ObamaCare didn’t increased the aggregate amount of healthcare that Americans are getting.
Since the supply of healthcare is constrained by too few doctors, the amount of healthcare is just being redistributed
It’s a zero sum game … previously uninsured people are getting more healthcare … previously insured people are getting less healthcare … and total healthcare delivered is staying about the same.
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I got a few questions about the incremental doctor shortage created by ObamaCare, so I pulled together a quick & dirty estimate.
Or, has it just covered more people with health insurance?
=========
In my consulting / problem-solving class, I emphasize asking the right question before starting to gather data, doing analyses, drawing conclusions and making recommendations.
Makes sense, doesn’t it?
Then, would someone please explain to me why the politcos (on both sides) obsess over health insurance coverage (how many people are covered) and largely ignore the quantity & quality healthcare that Americans are getting?
Source: AAMC
My conclusion: More Americans now have health insurance, but healthcare hasn’t increased … it has just been re-distributed.
Let’s connect a couple of dots today …
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A NY Times article explored “Why the Economic Payoff From Technology Is So Elusive”.
One example:
Look at this disconnect is in the doctor’s office.
Dr. Peter Sutherland, a family physician in Tennessee, made the shift to computerized patient records from paper in the last few years.
There are benefits to using electronic health records, Dr. Sutherland says, but grappling with the software and new reporting requirements has slowed him down.
Dr. Sutherland bemoans the countless data fields he must fill in to comply with government-mandated reporting rules…
He sees fewer patients, and his income has slipped.
The bottom line: over the years, due legal compliance and technology complexity, administrators (think: bureaucrats) have been added at a far faster rate than healthcare providers (think: doctors and nurses) …
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Hmmm.
Wonder why healthcare costs are so high …
What’s the link to college tuitions?
Make your guess before peeking ….
==========
Medicaid took center stage during the repeal & replace drama … so, I’ve been more alert to Medicaid news.
Let’s put today’s question in context.
According to MSN:
Over the past five decades, Medicaid has surpassed Medicare in the number of Americans it covers.
It has grown gradually into a behemoth that provides for the medical needs of one in five Americans — 74 million people.
For comparison … about half are on employer-based plans and “only” 14% are on Medicare.
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Here’s the geographic spread, according to the Kaufman Family Foundation:
Note the heavy Medicaid density in the West … and the relatively light density in the Heartland.
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OK, you have your frame of reference: about 20% of Americans on Medicaid.
So, what percentage of babies are born on Medicaid?
Let’s connect a couple of dots today …
A recent NY Times article explored “Why the Economic Payoff From Technology Is So Elusive”.
One example:
Look at this disconnect is in the doctor’s office.
Dr. Peter Sutherland, a family physician in Tennessee, made the shift to computerized patient records from paper in the last few years.
There are benefits to using electronic health records, Dr. Sutherland says, but grappling with the software and new reporting requirements has slowed him down.
Dr. Sutherland bemoans the countless data fields he must fill in to comply with government-mandated reporting rules…
He sees fewer patients, and his income has slipped.
The bottom line: over the years, due legal compliance and technology complexity, administrators (think: bureaucrats) have been added at a far faster rate than healthcare providers (think: doctors and nurses) …
=======
Hmmm.
Wonder why healthcare costs are so high …
What’s the link to college tuitions?
Answer: Apparently not if your boss is President Obama … and your project was ObamaCare.
In a conference call with reporters last week, HHS Secretary Sylvia Burwell said “We believe 10 million is a strong and realistic goal” for 2016 enrollment in ObamaCare Exchanges. That represents an increase not significantly different from zero.
Let’s put that number in context … and show how performance against plan is even worse than it initially appears.
I’ve been wrestling with a conundrum ..…
Mainstream media continues to tout the success of ObamaCare … always focusing on the number of previously uninsured folks who now have insurance.
Most recent CBO numbers say that about 19 million previously uninsureds now have insurance – mostly from Medicaid and subsidized ACA Exchange policies.
Now, about 80% of the non-elderly population is covered … but, about 36 million are still uninsured.
Said differently, over half of the previously uninsureds are still uninsured.
Huh?
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Let’s look at the cost …
ObamaCare added about $100 billion in annual government spending .
So, the cost per newly insured person is roughly $5,000 per newly insured person per year.
That sounds about right since an average individual health insurance policy is about $5,000 per year.
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OK, so what’s the rub?
Some simple arithmetic suggests that the aggregate monetary amount of insurance provided to the full population of non-elderly citizens has actually declined.
Here’s my logic …
Recently, a friend casually mentioned to me that his family finances were being strained by healthcare costs.
Why?
His family’s annual deductible had gone up from $2,500 to $12,500.
What?
Think about that for a moment … a 10-grand bump in out-of-pocket healthcare costs before the insurance even kicked in (with co-pays, of course).
======
The discussion piqued my curiosity, and I did some digging to put my friend’s predicament in perspective … what I found was surprising (and certainly under-reported in the main stream media)
According to the NY Times , the Harvard faculty is throwing a collective hizzy fit.
What’s their beef?
In a touch of irony, the same folks who cheer-led the passage of ObamaCare now feel aggrieved because they’re being forced to shoulder some of the costs.
To quote my grandson Ryne, “Oh me oh my.”
Here’s the scoop … with some priceless snippets from the Times’ article
We’ve been spending a lot of time at Georgetown Hospital recently.
In the process, we’ve developed a deep respect for some of the key cogs in the system: nurses, nurse practitioners and doctor-residents.
In casual conversation, our surgeon mentioned how she had managed to “survive her surgical residency”.
That got me wondering, about the life of a resident.
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Here’s what I found …
