Tuesday, July 08, 2008

The Short and Liberal View of Health Care

Everybody should make lots of visits to the doctor and government should pay for it.

Ok, that's not exactly what Jesse Taylor said in his long, rambling post on why he doesn't go to the doctor, but that's what it boils down to. Taylor says he's a healthy 25-year-old who either doesn't have insurance or doesn't have the right kind of insurance, so he doesn't use a family doctor and doesn't know anything about his shots. No offense to Mr. Taylor, but it sounds like he might need to just grow up a little and decide to take charge of things like finding a doctor and keeping up with his medical record.

I know that at 44, I'm an old fogey (at least, that's what Jeromy Brown claims when I point out the holes in his "I'm cooler, younger, hipper" arguments), but when I was 25, I had insurance and a family practitioner. I even had a separate OB/GYN that I saw every single year!

Now, a couple of things have changed in 20 years. One is the growth of CareNow-type doc-in-a-box places and the other is the decline of the family practice. I suspect the two are related somehow.

Taylor spends some time quoting from an article bemoaning the fact that so few medical students are choosing family medicine and general internal medicine as practices. Medical students are choosing other, more exotic fields several reasons besides money and student loans. Many of the reasons aren't discussed in the article, but considerations have to include prestige, hours, and the cost of insurance. Sure, an oncologist might have to pay more for insurance, but he's also getting at least three times what his family practice colleague makes. Bet he's not buying his dress shirts at Ross Dress for Less.

The upshot of Taylor's post is that our system sucks.

the big problem with our healthcare system is that it sucks for everyone. As much as we’d all love it if a new generation of young, soulful doctors came into family practice with a whole new attitude (this fall on ABC), we have an insurance system that encourages skipping extra steps and getting as little healthcare as possible to fix any given problem. We can make all the TV shows and send out all the proselytizers and forgive all the debt we want, but when the family doctor is the guy telling you that you’ll have to see the other guy you already suspected you’d have to see - and you’re paying for both visits - it’s hard to justify both visits.

I suppose if you are only looking at medicine as a cost analysis, this may be true. But, oddly enough, I always considered going to the family doctor because, most of the time, I wouldn't need to go to a pricey specialist. But maybe that's my age showing.

There isn't anything in Taylor's post to explain how we're supposed to fix this doctor shortage. Universal health care? That will increase wait times and discourage med students from going into family practice. Force med students into internal medicine? That was part of Hillary's original health care plan and it got rave reviews (/snark off).

Taylor may not like the answer, but not going to the doctor for toenail fungus or every cough is probably the right thing to do. Use some common sense. And find a regular doctor and stay with him or her.