A 2016 survey of patients in 11 countries-the U.S., Canada, New Zealand, and eight European nations-found that the U.S. trailed in providing timely access to primary medical care. High educational debts and fewer physicians push more health-care spending toward intensive and specialized services, which are more costly.
Naturally, some de reason that some homeowners object to more local construction: They’re afraid that abundance will eat their wealth. But they should consider the other side of the coin, which is that having more doctors might make life better for doctors, who work much longer hours than their European peers. Doctor burnout and brutal 16-hour shifts for residents and M.
That’s the question I posed to Robert Orr, a policy analyst who studies health-care policy at the Niskanen Center
The most obvious reason America needs an abundance of medical practitioners is … just look around. If COVID continues to be a problem for the U.S.-and that seems likely-we’re going to need more physicians, clinics, and therapies. Even if COVID disappears and the U.S. never faces another pandemic ever again (he wrote, fingers and toes crossed, after throwing a whole thing of salt over his shoulder), we’ll be an older and aging country with more sick people. The census projects that in 12 years, there will be more senior citizens than children in America for the first time in history. No matter what the pandemic future holds, we need more derica’s health-care system.
D.s aren’t necessary tests of willpower; they’re just the inevitable result of not having enough people to do the work that today’s hospitals demand
The first thing I would do is to expand the residency system so that more doctors can become residents after medical school, Orr told me. This might be the key bottleneck. The medical schools say they can’t easily expand, because there aren’t enough residency slots for their graduates to fill. But there aren’t enough residency slots because Washington has purposefully limited federal residency financing. The arithmetic is simple: More funding means more residents; more residents allows medical schools to grow; more medical students today means more doctors in a decade.
Countries get doctors in one of two ways-by training them or importing them. We’re bad at both. When NAFTA was negotiated, Canadians and Mexicans didn’t want to lose their derican market, and the U.S. didn’t want immigrant doctors to threaten U.S. physicians. As a result, to this day Mexican and Canadian doctors have to jump through special hoops to practice medicine full-time in the U.S.
Beyond increasing the number of doctors, states could increase the total supply of care by allowing more nurse practitioners to substitute for doctors. They could also expand legal telemedicine, which would extend care to rural and other underserved areas. The low-hanging fruit is to change Medicare rules so that the government would reimburse for all online appointments, Orr said. This would drive the permanent adoption of telemedicine throughout the system.
Finally, Orr said that we can’t expand the number of doctors unless we also expand the number of clinics and hospitals, particularly in the most underserved parts of the country. That means we have to build. We need a system of health-care-development banks that issue guaranteed loans for infrastructure projects, he said. That’s how the health-care system was originally built up until the 1980s, with government-backed finance.
M ore doctors, more clinics , more care, better health outcomes. It all sounded so obvious-too obvious. So, at the end of our conversation, I asked Orr to imagine all the ways we might be wrong. What’s the problem with an abundance of doctors?