Thursday, July 25, 2013

Today: A Modest Proposal For U.S. Healthcare

While preparing this post about national healthcare, this blogger is discomfited by a Holter monitor. This portable device continuously monitors various electrical activity of the blogger's cardiovascular system for 48 hours.

Rest assured that the photo comes from medical litarature (and this blogger's wishful thinking). The photo does represent this blogger's temporary device, not the blogger himself. In the midst of his current health ordeal, this blogger met an Austin cardiologist who entered medical school with a BA in history from UT-Austin. Not quite up to Deresiewicz's modest proposal, but startling nonetheless. If this is (fair & balanced) thinking outside the box, so be it.

[x TAS]
Heal For America
By William Deresiewicz

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America faces a growing shortage of primary care physicians, especially in chronically underserved inner-city and rural communities. By 2015, according to a recent report, the shortfall will amount to as many as 35,000 providers. Yet only about one-sixth of medical students intend to enter primary care. Deterred by poor reimbursement rates, low income relative to other specialties, and increasing patient loads—not to mention high levels of student debt—new MDs are opting instead for more lucrative fields.

I’d like to propose a solution. Every year, thousands of students graduate from America’s most prestigious colleges without a clear vocational direction. They are brilliant, hard-working, and eager to contribute to society. What better way to address our shortage of physicians than to organize these new graduates into a corps of energetic, idealistic young doctors and dispatch them to those same underserved areas? I envision a competitive application process, five-week summer training program, and two-year initial commitment. Sure, recruits are likely to feel overwhelmed at first, but what a life experience for them, out there on the front lines of the health-care crisis, making a real difference in people’s lives. More importantly, disadvantaged communities will begin to receive the medical attention they so desperately need.

I can already hear the objections. With little training and no experience, our new providers won’t be “real” doctors. What will they possibly have to contribute? But a lot of experts say that medical school is a waste of time. Poorly taught classes in tedious subjects like anatomy and biochemistry are no substitute for the enthusiasm, enterprise, and general awesomeness that our novice physicians will bring to the clinic. In medicine, knowledge and skill are less important than a can-do spirit. Besides, these kids are the best and the brightest, as their colleges are always telling them, quick studies in any subject to which they choose to turn their scintillating intellects. They’ll be up to speed in no time.

Will there be resentment from the other doctors—the ones who have been toiling in obscurity for years, unvalued, ignored, and underpaid—about having to work beside these Ivy League celebrities? Perhaps, but what matters here are the patients, not the sensitivities of a bunch of careerist hacks who have always been more interested, quite frankly, in protecting their professional prerogatives. If our new physicians help to break the power of the AMA, then so much the better. And if they accept the two years that society invests in them and then decide to take their talents to a different field, like finance or consulting—well, I’m sure they’ll be a friend to health care for the rest of their successful lives.

Besides, what is the alternative? Funding medical services for low-income communities at anything like adequate levels would take a lot of money. Not compared to what we give the Pentagon, but you know what I mean. America’s job creators aren’t going to stand for higher taxes, especially when incomes for the top one percent have gone up by only 11 percent since the start of the recovery. Our aggregate tax burden is already over 25 percent, more than half of what it is in Western Europe. We need to be realistic here.

Similar proposals have been made with respect to our educational system, but those, of course, are ridiculous. Everybody knows it takes years of training and experience to become a good teacher, and that students and schools need continuity, not a pack of self-congratulatory dilettantes who parachute in for a couple of years, then go off to Goldman or McKinsey with their newly burnished resumes. I could see it working for lawyers, though. Ω

[William Deresiewicz, formerly an associate professor of English at Yale University, is a widely published literary critic. His criticism directed at a popular audience appears in The Nation, The American Scholar, the London Review of Books, and The New York Times. Controversial, more often than not, his negative reviews of Terry Eagleton, Zadie Smith, and Richard Powers drew heated reactions within the literary community. In 2008 he was nominated for a National Magazine Award for reviews and criticism. Despite the publication of Jane Austen and the Romantic Poets by Columbia University Press in 2004, Deresiewicz was denied tenure at Yale in 2008. His most recent book is A Jane Austen Education: How Six Novels Taught Me About Love, Friendship, and the Things That Really Matter (2011). He received both a BA and a PhD from Columbia University. Currently, William Deresiewicz blogs in The American Scholar (All Points) about American culture with new posts each Monday.]

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