When is the last time you had to make an appointment with a specialist, or visit the emergency room?  Well, I can tell you this, whenever our family  has, the wait to get an appointment or be seen by emergency room doctors has been extraordinary.  I was seeking an appointment with a urologist- 7 weeks until the soonest opening- and this was after checking with numerous doctors and clinics.

Visiting emergency rooms as we have had to do with a 140# high school son playing varsity  football.  Three hours to get seen by a physician’s assistant only to be told, “I think you’ll need X-rays”.  And why the three hour wait, I am sure there are a number of reasons, however, what we could see and hear from those waiting.

“I can’t go to my regular doctor because he can’t see me for a week”

“I can’t go to my regular doctor because I have not met my deductible”

Our family has a good friend who works for a medical group.  He requires special permission to spend more than ten minutes on any one patient-  A time constraint that he readily admits has caused him to misdiagnose a few patients who subsequently died or suffered a debilitating injury.

And we see mostly people with aches and pains that perhaps need a little advice, but far from being an emergency,  Issues that could truly be handled by a PA or RN, flooding the emergency rooms, resulting in excessively long wait times,

So what this really comes down to is this”  Supply and demand.  We have too many people and too little physicians.  And while the demand keeps growing, the supply ratio of doctors to the growing population continues to decrease, with most medical professionals coming from foreign countries.

Why is this?  The cost and availability of education.  Just how expensive and how difficult is it to become a doctor?  Just expensive and difficult enough to keep qualified and interested  people from pursuing a career in medicine.  We need to find a way to convince more and more people to pursue a career in medicine.  We will do this by making education more affordable, more accessible and more attractive -   Simply graduating medical school with a student loan bigger than your home mortgage is not attractive enough  to qualified and interested medical students.

The military offers to educate students, in medicine, as long as they agree to serve one year for every year of schooling received. Certainly a valid approach to securing aspiring doctors that otherwise would not pursue a medical career due to the cost.

In Ohio, they have started a program where they will pay for your medical school, and subsidize the cost, if you agree to practice in Ohio for asset number of years.  A great start at making education affordable, but what about accessibility-  The capacity of schools would have to increase substantially.  If the American government is truly interested in providing long-term affordable medical care, it would invest in  Government sponsored medical schools.   The Feds need to invest in increasing the number of medical schools.  You need only look at the cost of dentistry over the past twenty years.  It is down considerably, and become much  more affordable.  Why, because there is a dentist on every street corner.  The number of dentists has exploded, making it more competitive.  And it is precisely this competition that has driven the prices downwards. 

As a conservative, who does not believe in government competing with the private enterprise, this may appear contradictory, but haven’t all medical schools, let alone colleges, already crossed that line.  If the government is going to heavily regulate the medical profession, toss billions into education in the way of grants to build massive universities that only serves to increase the cost of education, then the government needs to place stipulations on the money it gives away. And, if the private sector is not going to respond to the market demand, then the government should.  And they should by providing a direct service and not tossing money at already inept systems.  Clearly, the educational institutions of the is country went astray with all of the billions offered to them by the government, simply increasing their tuition, building monuments to themselves, resulting in alienating more and more prospective students.

In a small town just outside Pittsburgh, PA, there is a non-profit school, Manchester Bidwell, that offers certificated courses in pharmaceutical technology.  The lab, curriculum and many costs are born by Bayer.  Yes, corporate America.  Why, because they need all of the lab techs, pharmaceuticals technicians they can get.  This non-profit school run by Bill Strickland has a 100% job placement rate.  An incredible example of how affordable education translates into more qualified personnel.

After increasing the number of physicians and related medical personnel, the goal should be to create enough walk in clinics to handle the non major issues that most people have who are clogging the system and preventing those with serious issues to gain quick and efficient help.  Walk in clinics manned by the students or those who were provided an education by the national system. 

Next, allow these clinic and emergency rooms to administer minor help with zero civil risk.  Come on, $12 for a Tylenol!  $650 for X-rays- The extraordinary costs of medical care, are a culmination of many things, but certainly we cannot ignore the civil litigation associated with providing medical care- Why should a doctor have to pay $150,000 per year for malpractice insurance.  If that doctor is securing a qualified education and licensed through the whatever mandatory licensing requirements there are, then the government should provide all insurance for all doctors in good standing.   Imagine the effect on civil litigation and awards if the government was the insurer.  No doubt that there would be legislative overhaul and tort reform.  The best way for the federal government to contribute to lower medical care, is to address the controllables.  And litigation is one of these controllables.  The feds become the insurer.  False claims now become a federal offense.  Doctors and those in the medical profession should be offered civil immunity.   If the feds are going to license them, and the doctors acted with no malice, then they should be immune to civil claims and exorbitant malpractice insurance premiums. Let’s face it, medical care is a privilege.  A privilege afforded by an advancing society.  A privilege that we are all free to pursue or to not pursue.  It is not a guarantee.  It is a best effort on behalf of individuals who dedicating a large portion of their lives, incurred substantial debt, undergo tremendous job related stress, who  utilize whatever technology there may be to provide a service.  Some people value their comfort enough to take a calculated risk.  And absent a malicious misconduct, as opposed to an oversight or lack of ability or mistake, I am not sure what gives a person the right to pursue excessive civil damages.

One of the biggest expenses in running a medical office is running the business of the front office, especially, filing insurance claims.  Standardize the  medical claim form and procedure that all insurance companies must adhere to and comply with.  The more efficiently a doctor , medical group, hospital gets paid, the less loss they incur, and the more costs can be controlled.    Compliance with the universal claim form would ensure immediate payment by the insurance carrier.  If not, the insurance company would be fined fine.

In conclusion, the cost of health care to the middle class American, can be greatly reduced by implementing the  following mandates:

1:         Make the cost of medical school free for any citizen of the US, with a stipulation that they contract to provide medical service at a pre-determined salary for 4 years.   The salary must be attractive and competitive

2:         The US government becomes the insurance underwriter  for all medical practices, malpractice  and overhauls tort reform

3:         US government invests in smaller community based medical clinics manned b graduates of the new medical program to handle non-emergency issues

4:         Standardize insurance claim forms throughout entire industry.  Mandate compliance

5:         Invest in and incentivize corporate sponsorship of training and education for ancillary jobs such as pharmaceutical technicians, like Manchester Bidwell of Pennsylvania.

6:         Mandate expedited approvals by local governments of all  medical related construction, including hospitals, doctors offices, pharmacies, labs, etc…Eliminate any  hurdles such as EIR, traffic studies, biological reviews, etc. Even go as far as having pre approved drawing of various community clinics and hospitals that can be built anywhere with no additional approvals - 

7:         Offer government insured loans at reduced interest rates, for the development of any pre-approved medical practice.