US Medical - Part 1

The Physicians for a National Health Program website said that during the Progressive Era that although President Theodore Roosevelt (1901 — 1909) believed that no country could be strong whose people were sick and poor and as such supported health insurance, most of the initiatives for reform took place outside of government. Roosevelt’s successors were mostly conservative leaders, who postponed for about 20 years the kind of presidential leadership that might have involved the national government more extensively in the management of social welfare; ever since the US has been pursuing a national health care program.

A USA Today March 2, 2005 article said studies say - The country needs to train 3,000 to 10,000 more physicians a year — up from the current 25,000 — to meet the growing medical needs of an aging wealthy nation. Because it takes 10 years to train a doctor, the nation will have a shortage of 85,000 to 200,000 doctors in 2020 unless action is taken soon. The predictions of a doctor shortage represent an abrupt about-face for the medical profession. For the past quarter-century, the American Medical Association (AMA) and other industry groups have predicted a glut of doctors and worked to limit the number of new physicians. In 1994, the Journal of the American Medical Association predicted a surplus of 165,000 doctors by 2000. "It didn't happen," says Harvard University medical professor David Blumentha . .  . "In fact, we're all gainfully employed, earning good incomes, and new physicians are getting two, three or four job offers." The nation now has about 800,000 active physicians, up from 500,000 20 years ago. They've been kept busy by a growing population and new procedures ranging from heart stents to liposuction. Even the AMA, the influential lobbying group for physicians, has abandoned its long-standing position that an "oversupply exists or is immediately expected." A July 1, 2010 article in the Arizona Republic reflects this saying - the estimated 2010 national ratio is about 299 physicians per 100,000 people but Arizona and many others states are far below this level. AMA has also aggressively lobbied for many restrictions that require doctors to carry out operations that might be carried out by a cheaper workforce. For example, in 1995, 36 states banned or restricted midwifery even though according to studies it delivers equally safe care to that by doctors. According to the consensus of economists the regulation lobbied by the AMA has decreased the amount and quality of health care - the restrictions do not add to quality, they decrease the supply of care. Moreover, psychologists, nurses and pharmacologists are not allowed to prescribe medicines. Previously nurses were not even allowed to vaccinate the patients without direct supervision by doctors. And, only 36 states require that health care workers undergo criminal background checks.

In the fragmented US health care system many patients and their providers experience problems with care coordination. For example, a Harris Interactive survey of California physicians found that 40% of physicians reported that their patients have had problems with coordination of their care in the last 12 months; more than 60% of the doctors reported that their patients "sometimes" or "often" experience long wait times for diagnostic tests and 20% of the doctors reported having their patients repeat tests because of an inability to locate the results during a scheduled visit. Many primary care physicians no longer see their patients while they are in the hospital. The use of hospitalists is sometimes mandated by health insurance companies as a cost-saving measure which is resented by some primary care physicians. The use of hospitalists fragments care because hospitalists usually have no previous relationship with the patient and do not have a personal knowledge of the patient's medical history. A study by Johns Hopkins University found that roughly 1 in 4 patients believe their doctors have exposed them to unnecessary risks and anecdotal evidence such as self-help books and web postings suggest increasing patient frustration. Possible factors behind the deteriorating doctor/patient relationship include the current system for training physicians and differences in how doctors and patients view the practice of medicine. Doctors may focus on diagnosis and treatment while patients may be more interested in wellness and being listened to by their doctors.

A New England Journal of Medicine article of October 1, 2009 said - Overall, a majority of physicians (62.9%) supported public and private options for health care; only 27.3% supported offering private options only. Respondents — across all demographic subgroups, specialties, practice locations, and practice types — showed majority support. Primary care providers were the most likely to support a public option (65.2%); among the other specialty groups, the “other” physicians — those in fields that generally have less regular direct contact with patients, such as radiology, anesthesiology, and nuclear medicine — were the least likely to support a public option, though 57.4% did so. Physicians in every census region showed majority support for a public option, with percentages in favor ranging from 58.9% in the South to 69.7% in the Northeast. Practice owners were less likely than non-owners to support a public option (59.7% vs. 67.1%), but a majority still supported it. Finally, there was also majority support for a public option among AMA members (62.2%). Overall, 58.3% of respondents supported an expansion of Medicare to Americans between the ages of 55 and 64 years. This support was consistent across all four specialty groups, with proportions in favor ranging from 55.6% to 62.4%.