ALLEN: Looming health-care crisis

By Van Allen | Friday, September 5, 2008

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COMMENTARY:

The U.S. Census Bureau this week reported the number of Americans without health insurance fell last year to 45.7 million, down from the previous estimate of 47 million. Good news for sure, but of little comfort to those families and individuals still without coverage.

Despite the positive development, access to health insurance will remain a major focus of the presidential campaigns, and with good reason. There is a looming health-care crisis in this nation, and candidates Barack Obama and John McCain offer different solutions to lower insurance costs and extend coverage universally.

The rhetoric sounds good on the stump, but it ignores the fact that universal health-care coverage won't do the nation any good if there aren't enough doctors to provide needed health-care services.

There is already a dire need for more physicians in this country, and fewer students opt to pursue a medical education even as demand for medical services grows. While America's physician population grows older, the math simply doesn't work in the patient's favor: The American Medical Association says 35,000 doctors per year reach retirement age while U.S. medical schools only graduate 8,000 new doctors annually in replacement.

The problem is exacerbated by a growing sense of discontent among younger physicians, driving them out of the profession. Last year, for example, the Massachusetts Medical Society found that more than one-third of doctors in the Bay State were considering abandoning the profession because of high stress, increasing administrative burdens, skyrocketing malpractice insurance costs, and the constant threat of lawsuits - conditions affecting physicians across the country.

In rural America, the problem is even more acute. In places like my home state of Missouri, physician shortages in rural communities have been a longstanding challenge to providing residents with quality health care. Average wait times to see a specialist - when you can find one - in many places are measured in weeks. In some locations, patients may need to drive an hour or more to find a doctor. Many go without.

The University of Missouri School of Medicine and other med schools have created innovative programs to encourage medical students to practice in underserved rural communities, but it's not enough. Jack Colwill, professor emeritus at the University of Missouri, co-authored a report in the May/June 2008 issue of the medical journal Health Affairs predicting a 44,000 shortfall in family and general practitioners by 2025 as more and more students chase more lucrative careers in nonessential specialties.

The promise of universal health care is attractive, to be sure, but the implications of such a remedy may be worse than the cure. We need only look to our north, to Canada, to understand the detrimental effect universal health care will have in our own country.

A 2006 survey by the College of Family Physicians of Canada found that, despite universal health care, 17 percent of Canadians go without regular care because they do not have a primary care physician. There simply aren't enough doctors to meet the demand.

Incidentally, 17 percent of the U.S. population is 51 million. That means that by extending insurance coverage to every man, woman and child in the country through federal fiat, we'll have taken a giant leap backward in our effort to improve the health-care system. By creating the kind of additional bureaucratic layer already driving doctors away, we'll have added more than 5 million to the ranks of the effectively uninsured.

The Canadian example hints at even more bad news for rural America under a universal system. Economist Pierre Lemieux observed of Canada's national health-care system that, over time, doctors have fled rural Canada to practice medicine in urban centers, taking advantage of the economics of operating within a larger practice or hospital. The result has been rural physician shortages and urban bed shortages.

Even more troubling from a social welfare perspective has been the emergence of a "cash-and-carry" market for medical services. Wealthy Canadians, operating independently of the national insurance system, have access to top-quality medical care through private practices that cater to a clientele with the means to afford the best, drawing good, entrepreneurial physicians away from serving the public at large.

None of this bodes well for an American heartland desperate for adequate medical care.

Volunteer medical groups such as Remote Area Medical, Flying Physicians International, and other charitable medical organizations experience overwhelming response to their missions in rural American communities. And this year's devastating Midwestern floods illustrate how quickly needs may arise for rural hospitals and health-care facilities.

Viable solutions to the problems faced by America's rural medical industry - and patients - will not be easy to achieve, but they won't be addressed through short-sighted political promises and reckless experimentation, either.

In this election season, the economic and medical stakes are high for many Americans. Voters and the media must push the candidates to offer honest and realistic assessments about how they plan to expand coverage for the most vulnerable citizens - without driving more doctors and potential doctors out of the healing profession.

Van Allen is chief executive officer of TimeLine Recruiting, a physician recruitment firm in Columbia, Mo. Visit TimeLine Recruiting online at www.tlrec.com.

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