Health Care Reform: Considering Solutions

It seems the entire country is in the midst of debating what may be the most significant piece of legislation this century. Debates over the proposed Health Care Reform bill rage in Congress and on TV, over the radio waves and in the homes of almost every citizen. Everyone seems to have an answer and everybody else thinks they are wrong. So, the debate continues and tempers are flaring.

What will it take to fix this growing and worrisome problem? Will it take a massive overhaul of how health care is delivered in our country? Will it take what amounts to a full-blown government take over of a private industry? Will it take a combination of those ideas? Only one thing is certain at the moment: US health care seems to be in critical condition and the solutions to the problem are as controversial as anything could be.

While the debate rages around us, let's take a step back and look at what may be causing the problem and what may the simplest way to understand the solution: Good old fashioned supply and demand.

In 2004, the World Health Organization reported that there were roughly 786,000 practicing doctors in the United States. Population at that time was hovering just above the 300 million mark. Not counting nurses or other practitioners, 786,000 equates to one doctor for every 381 people.

Even though we know better, let's imagine that the US population hasn't grown in five years and the total number of doctors hasn't gone down. At 2004 levels, a doctor would need to see 63.5 people per day for 6 days to see his or her 381 patients. Visiting each one for 30 minutes (a high figure these days) the doctor would need to spend 11,430 minutes - which is 2,790 minutes more than is available in those 6 days. That equates to 46.5 hours which is another full time work.

I know I am using an overstated model to make my point - not everyone of those 381 people needs to see the doctor every week. So, the work load is spread out over a greater time. Nonetheless, when you wait in your doctor's office for more than an hour for a 15 minute visit, you can see that the demand for service is far outpacing the supply.

In any economic model, when demand for something is greater than the supply, the price is driven upward. When supply is high and demand is low, the price goes down. It's a basic economic concept that can get quite complicated when we try to control natural forces with artificial solutions - and that's just what we're doing.

So far in our country, we've attempted to make things easier for people by applying controls on the pricing of medical care. The first major influence in this cycle came at the end of the 1800s in the form of health policies which later evolved into the current medical coverage plans. Much later, the US government subsidized a portion of the medical costs for retirees via 1965's Medicare program.

While the combination of private insurance and government subsidy helped ease the financial burden on individuals, it did nothing to address a growing population and a stagnating supply of health professionals. In other words, an artificial support for demand was created without the corresponding and critical increase in supply needed to keep prices from skyrocketing.

Today, we are once again debating various ways to make it easier to bear the individual cost of health care, and ways to get more and more access to more of the population. However, in the midst of that heated debate, we are once again doing very little to address the static - if not shrinking - supply of medical services relative to an ever-increasing population.

We must then ask ourselves a difficult question: Will the proposals put before the American people actually help or hurt? Without increasing the number of doctors, nurses, clinics and hospitals able to provide service to a growing population, the answer is it will hurt and hurt badly in the long run.

So, what can be done? The answer is complicated and yet elegantly simple all at once. We need more medical schools. We need more hospitals and doctors to staff them. We need to do what we can to increase the available supply of medical care rather than focus our all of out attention on the demand for more and less expensive care.

The US Government currently runs five major military academies. The United States Military Academy at West Point, The United States Naval Academy, and The Air Force Academy in Colorado, The Coast Guard Academy and the US Merchant Marine academy.

Students from all over the country compete for a spot in these prestigious universities and, in exchange for a world-class education, commit themselves to an average of five years of active duty in the service represented by the school they've chosen.

One possible solution to our current situation is to develop a similar system specific to the medical profession. The establishment of a US military style academy offering a complete general practice medical education in exchange for a number of years of service in public hospitals or clinics would - over time - increase the total number of practicing doctors in the US.

As these new doctors complete their service and move into private practice, the supply of doctors will increase and the cost for basic service should begin to see declines. If we imagine that natural force working in combination with more and more people having access to preventative care, we can see an even greater benefit in terms of cost reduction and an overall decrease in demand for the most expensive type of care. The net effect over time is more affordable and better access to health care for all Americans without the need for ever-increasing subsidies and the skyrocketing premiums or taxes to pay for them.

Would we need to create an entirely new branch of uniformed service to make this a reality? Actually, no. The service has existed since 1798 and is very active today. Probably the least known uniformed service in the US, The United States Public Health Service Commissioned Corps was established more than 200 years ago by President John Adams Today, the Corps recruits and supports over 6,000 highly trained medical professionals whose mission it is to support public health and disease prevention across the country.

Perhaps it's time to elevate this honorable service to the same level of awareness enjoyed by the other branches of our military and to authorize the establishment of an academy -perhaps more than one - for those young people who would dedicate themselves to a lifetime of practice in medicine.

As we debate how much of our tax dollars we want to commit to solving this growing problem, it may do us good to remember that providing a steadily increasing supply of doctors to the citizens of the United States is the surest way to make access to health care both universal and affordable.

http://apps.who.int/globalatlas/dataQuery/reportData.asp?rptType=1

http://www.usphs.gov/aboutus/history.aspx