Simplifying Obamacare (Continued)
Beefing up the healthcare workforce
Right now we have 53 million uninsured Americans, about 17% of our population. The ACA aims to reduce this number to 22 million people by 2019. But with wait-times to see a doctor already weeks, or even months in some places, how will the healthcare system handle this influx of 31 million new "customers?"
The ACA sets aside hundreds of millions of dollars to boost the number of primary care doctors, dentists, mental health providers, physician assistants, nurse practitioners, and nurses via scholarships and loan repayment programs for health professionals who are willing to work in under-served areas.
And this strengthening of the workforce isn't just limited to recruitment. Another arm of the program funds retention efforts, especially for nurses, where high career dropout rates are the norm. Bonus payments will also be provided to primary care docs, a job in medicine that's currently an endangered species.
The overall goal is to expand the healthcare workforce by 25% over the next decade.
Beefing up the healthcare infrastructure
But all those new professionals need places to work, so the new law is also expanding health centers across the country, setting aside 11 billion dollars over five years, of which $728 million was just granted. The crafters of the law realized that the community health center would become the backbone of the expansion of health access, the site that most of the newly-insured will go for care.
(Sadly, my clinic, although we applied, wasn't funded. We must go on practicing medicine out of a ramshackle collection of tuff-sheds, "portable" trailers, and a building so small that our computer guy's office used to be the men's bathroom.)
Trying to figure out what works
The ACA establishes a non-profit independent research institute to study the comparative effectiveness of various therapies, treatments, meds, and gear. It's charged with both evaluating existing studies, and undertaking new studies of its own.
This is the so-called "death panel." Don't worry. Grandma is safe. The institute is as toothless as she is. It has no direct authority at all. It provides recommendations for coverage, but Medicare and Medicaid, by law, cannot make coverage decisions based solely on its advice. Also, the institute itself is barred from using the British "dollars per quality adjusted life year" approach to evaluating the effectiveness of medical interventions. Instead, it's firmly entrenched in the growing trend of evidence-based medicine.
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Every writer has a collection of posts, letters, essays, books, and/or poems he has started but never completed; drafted but never edited; submitted but had rejected. In jargon, these are called "the morgue". In effect, they are "dead" ideas which have never come to life. Some of the entries in my morgue are there because they are no longer timely — a 2012 piece starting with a bicyclists' protest in Brazil, for example; others are there because they've...