<p>Fascinating article, Calmom. And merit badge to dstark for finding the appropriate emoticon. </p>
<p>Side comment: I know what you’re doing, ds, on several levels. But of course some are entrenched. I’ve been waiting for, so to say, the “ok, I see that,” so we can get on to the next topic- and we’re only as far as “yes but,” with emphasis on the “but.” And we backpedal. I think you know what I mean.</p>
<p>I also like the article- what excites me (and this is another side comment) is the strategy behind it. Obviously, to me, the authors had very unique access. Very. I was waiting for the master strategists, like the groundhog, to poke their heads out of the hole and get back to countering the poor press. We can step back from the detail and see the purpose in the article. Gets a yay from me.</p>
<p>I can understand what it conveys, worked with those sorts, but another strategic question is rolling around in my head- the article is aimed at those who can comprehend it, not the guy on the street, not the guy on the end of the phone call from Gallup (if he reads it, will he read it all?,) not the entrenched. But it’s not in the computer- or software-related media. It’s in Time. So, what’s the expectation? That “we” will go convince out neighbors? Or that the info will trickle out to more of the common media, your hometown press? Don’t know.</p>
<p>Anyway, I want the term “Fang’s Razor” to enter the common lingo. I feel sort of privileged to have been there at its start. I am going to use it in my life away from CC. Thanks.</p>
<p>We need time to see how ACA works. It’s not a sale at WalMart where you can reasonably expect all the shelf labels are in place by 6am and the cash register will properly price it for you. It is freaking massive. It will hiccup and burp. Of course it will.</p>
<p>“Anyway, I want the term “Fang’s Razor” to enter the common lingo.”</p>
<p>All it needs is for a few to start using it on Twitter and a wiki page. 
</p>
<p>I love the Time article. Steven Brill knows how to write a page-turner. But then, I was pretty much guaranteed to love an article that features people like me, nerdy software engineers, as heroes, and the people that annoyed me when I was employed, management and marketing that got in the way and promised things they had no idea how to deliver, as the goats.</p>
<p>LF, I am not delusional. Some people will never change their minds. </p>
<p>I have a friend that is just like GP. </p>
<p>Anyway… I would tweak the numbers to make them a little more accurate but what is the point? The message is the same. The numbers are close enough. The young not signing up is not a problem. </p>
<p>I am having fun or I wouldnt do what I am doing.</p>
<p>The March sign ups are coming. One thing that isnt mentioned much here is that some of the uninsured are not signing up on an exchange. So… Even if 80 percent pay… The off exchange sign ups will pick up some slack.</p>
<p>One thing about the Time link is it shows how targeted the uninsured can be. Pretty amazing. We can see why Obama won the by the way the voters were targeted. </p>
<p>Enroll America is out there with the data. Backed by the insurance companies and others. To sign up the healthy uninsured. </p>
<p>We will see how Enroll America and organizations like Enroll America do this month.</p>
<p>I know you are not delusional. You knew that, right? </p>
<p>Yes…</p>
<p>"Busdriver wrote:</p>
<p>if your kids were going to med school regardless, not quite sure how it is a net positive to have us pay for it instead of you"</p>
<p>Calmom wrote: "I think it’s wonderful if you have the financial ability to fund a child through medical school – but that is very rare. I certainly cannot fund my children through grad school – and the offspring of CC parents are better off than most if they’ve had their parents subsidize the the bulk of their undergraduate education.</p>
<p>The vast majority of med students will pay their own way, and by “pay” that means either taking on a 6-figure debt for most, though some will choose to enlist and serve in the military for the sake of the educational benefits.</p>
<p>If the goal is to get more primary care physicians in high need communities, then it makes sense for the government to subsidize those students. The parents who are paying their kids’ med school bills and living expenses probably have something different in mind for their residencies."</p>
<p>I was speaking specifically about the two posters discussing it. I believe that both dstark and texas were talking about paying for their kids med school. Now they could change their minds, or I could have been mistaken about that. But for those people who were going to med school anyways (whether their parents were paying for it or they were), I don’t see that it’s a beneficial investment for the taxpayer. Unless, of course, the govt can get a set in stone commitment that they must work in certain hard to fill positions.</p>
<p>In the past, it has been hard-to-fill positions. On or near reservations, in the poorest or most rural communities, severely understaffed and/or without the next level facilities nearby (so the burden on the young doc is higher than a usual first job.) And a definite time commitment. <a href=“Loan Repayment | NHSC”>http://nhsc.hrsa.gov/loanrepayment/</a> Not arguing, but to me, it makes a lot of sense.</p>
<p>My young friend came out with 300k in debt. She’s brilliant- except when it came to this financial matter. </p>
<p>But I thought the change being discussed was to have Medicare fund more residencies. Medicare already funds residencies-- they are not paid for by residents. And we can’t produce more doctors without more residencies for med students to go to when they graduate from med school. </p>
<p>I’m fairly unconvinced that what we have is a shortage of doctors. There were some interesting stories a few years back in the Denver Post about the rural doctors program, and how little work there was for most of the doctors put in those environments. Added to that, there was a paucity of tech resources, and a feeling that the many years of residency were frequently overkill for the kinds of chronic health conditions they were encountering. Several of the doctors liked the areas in which they worked, but just didn’t have enough patient volume.</p>
<p>What if instead of trying to create more and more docs (at higher and higher cost) we did more to meet remote healthcare needs through NPs and PAs and visiting nurses, supported by an effective telemedicine system? (Our state is one that is testing – with insurer support – telemedicine)</p>
<p>We’ve already made a fair number of changes due to density issues in education (many rural school districts spanning large areas run on a four day school week, AP classes at tiny high schools are often delivered via on-line or telecourses, school transportation funding reflects rural challenges, parents can be paid mileage to transport kids to school where school buses would be uneconomic,…)</p>
<p>I’d guess that most of us live in urban or suburban areas. The challenges faced in really rural America can be a lot different. The number of specialists in the metro area in a plan is pretty immaterial to the folks living out near the border between Colorado and Kansas.</p>
<p>Folks living in remote rural areas go to the big regional hospitals when they have serious medical issues. The local doctor is needed for acute emergencies and routine care in rural areas. </p>
<p>I agree that we should use more NPs and PAs, and not just in rural areas. NPs/PAs can and should also handle things like well baby visits and coordinating care of the chronically ill like diabetics. </p>
<p>The ACA includes funding to produce more NPs and PAs.</p>
<p>In my doc’s practice, the NP and PA operate same as the docs, more than just the light things. I believe PA is where we will see the surge and maybe where we should be directing some of our kids. It’s a high level, multi-year training. </p>
<p>" What if instead of trying to create more and more docs (at higher and higher cost) we did more to meet remote healthcare needs through NPs and PAs and visiting nurses, supported by an effective telemedicine system? (Our state is one that is testing – with insurer support – telemedicine)"’</p>
<p>I agree with that. While people definitely need to have access to a doctor, sometimes a skilled NP and PA can do just as good a job. Interesting, telemedicine. Hadn’t heard of that.</p>
<p>Here’s a cool article on how telemedicine is being used now in Colorado <a href=“Telemedicine helps doctors beam into rural hospitals, treat newborns – The Denver Post”>Telemedicine helps doctors beam into rural hospitals, treat newborns – The Denver Post;
<p>One of my hopes for insurance coverage is that there will be better ways of compensating doctors and other health professionals for services provided electronically. I’d way rather have a ten minute teleconference with my doc to review a medication status than trek in, park, sit in the waiting room, and then have a ten minute visit that doesn’t involve much physical exam other than bp, temp and pulse, all of which I could do from home. I’d happily pay for the visit. (This is like the drive-by air pollution monitor – I’m happy when I get my car renewal and don’t have to go to the testing station, even though I still have to pay the equivalent of the test fee. It is an hour and a half I will never otherwise get back.)</p>
<p>Hmm. Last time I went to the doctor for a rash they took a photo and transmitted it to a dermatologist and emailed me a diagnosis the next day. Between the fumbling with the camera and the fact that the doctor couldn’t diagnose a simple rash I was not impressed. But, the application in the article sounds interesting.</p>
<p>Telemedicine depends somewhat on the patient and what’s being monitored. There are many things a doc looks for (and doesn’t mention) that won’t come through on skype. In some areas, they’ve been using online chat to diagnose for Rx- it had been unregulated, but drew a lot of criticism. Don’t know current status.</p>
<p>
Parents who are paying to educate their offspring are unlikely to encourage the students to opt for the type of residencies being subsidized, as it is far less lucrative in the long term to be a primary care physician in an underserved rural community. Much better to train into a high-paid speciality at a top research facility in an urban area. And students who are looking at 6-figure debt coming out of school are equally incentivized to train in the areas likely to produce the most income in the long run. So it makes sense for the government to get involved in financing students who can fill the less lucrative positions down the line, providing medical services to a needier patient base.</p>
<p>I agree that it also makes sense to shift to more use of public health nurses and rely more on technology – but there are many medical needs that do require a doctor working hands on with a patient. I mean, I don’t think paramedics should be expected to perform an emergency c-section, nor do I see how that could be managed via teleconferencing. That’s a essentially a triage issue, but it doesn’t eliminate the need for qualified medical doctors in regions where there are shortages. </p>
<p>“Hmm. Last time I went to the doctor for a rash they took a photo and transmitted it to a dermatologist and emailed me a diagnosis the next day. Between the fumbling with the camera and the fact that the doctor couldn’t diagnose a simple rash I was not impressed. But, the application in the article sounds interesting.”</p>
<p>We had a different experience with my husband. He had a serious knee injury, rushed to the emergency room, they transmitted the x-ray to a specialist. He determined what needed to be done quickly, gave my husband an appt the next day, surgery soon after. Much cheaper than having a specialist have to come in to the hospital.</p>
<p>Fascinating article. That is incredible that they are able to do that, but I guess with today’s technology, what used to be Star Trek fodder is now reality.</p>