November 11, 2024 Breaking News, Latest News, and Videos

Obamacare Problems: Doctor Shortage, Honor System:

Add between one million and two million persons to the patient load of California doctors. Do not open any new medical schools or import many foreign-trained doctors. It’s a sure-fire way to create a doctor shortage – and just where California is headed right now.

That’s probably the most severe problem the Patient Protection and Affordable Health Care Act, often called Obamacare, faces in California when it becomes fully active Jan. 1, but it’s hardly the only one. There are insurance companies refusing to write policies for some small businesses. And how about the fact that the federal government at least for the first year of the program will not demand any kind of proof that people actually qualify for subsidies designed to make health insurance affordable to almost everyone.

Instead, a kind of honor system may be in effect. “For income verification, for the first year…, we are providing exchanges with temporarily expanded discretion to accept an attestation of projected annual household income without further verification,” says a rule officials just inserted into the Federal Register.

This applies to states like California that have their own insurance exchanges, although the Covered California exchange says it might still demand pay stubs or their equivalent from clients. “That’s always been our plan, but since verification is now not required, we’re looking at our options,” said spokesman Dana Howard.

Which means that rule could cost billions in fraud if some of the newly insured lie about their income and don’t get caught.

But the impending doctor shortage could actually be life threatening, making it the most severe problem that Covered California might face next year.

Take the example of Orange County. California’s second-largest county will see as many as 280,000 persons now without health insurance suddenly become eligible next year. That includes new Medi-Cal patients previously ineligible because they were childless or had too high an income. A single adult can now get Medi-Cal with an income of 138 percent of the federal poverty level, or $15,856.

Most will probably go to clinics for their primary care. But will those clinics have the personnel to take care of them? In Orange County alone, a population almost as large as Fresno’s will suddenly be entitled to care, but there will be virtually no new doctors.

That’s one reason for the steady progress through the Legislature of several bills giving non-physicians more authority to perform some types of medical care.

These would let pharmacists, nurse practitioners, optometrists, physician assistants and nurse midwives perform some functions now reserved for medical doctors.

“Pharmacists are the most underused of health professionals, considering their years of education and training,” says Democratic state Sen. Ed Hernandez of West Covina, author of the most sweeping bills to let non-doctors perform more medical functions.

Many pharmacists no longer spend most of their time counting pills or filling medication bottles. Technicians and automated pill counters can do those things. Instead, many pharmacists now spend significant time counseling patients on possible drug interactions when one doctor writes a prescription without knowing what another has already written. Pharmacists also often ask patients about their ailments and advise which drugs might work best for them.

Hernandez’ bills would let pharmacists prescribe birth control pills, vaccines and some other types of medication on their own. He contends they already do a lot of that, de facto, but doubts remain. Would pharmacists, for example, know what vaccines are appropriate for organ transplant recipients?

The long-term answer to the physician shortage is to set up more medical schools and train more doctors. But since Medicare, Medi-Cal and other programs have gradually cut fees they pay, an M.D. degree may no longer be an automatic ticket to wealth and medical schools could have trouble attracting the top students they traditionally have.

There’s also the small matter of how long it takes to train a doctor – 10 years or more for some specialists. So it will be awhile before the doctor shortage is overcome, and despite opposition from the California Medical Assn. and many physicians, this means somebody besides doctors will have to provide some of the care for the newly insured. Like it or not, comfortable or not with non-physicians making some medical decisions, that’s the coming reality.

in Opinion
<>Related Posts

SM.a.r.t Column: Moving Ahead to the Future

November 10, 2024

November 10, 2024

As we write this, the election results are still trickling in. We’ll leave the deep analysis to others, but the...

Opinion: Fact Check: Why Vote Yes on Measure QS

November 1, 2024

November 1, 2024

Despite living in a famously progressive region, Santa Monicans are not immune from the same political misinformation and disinformation that...

SM.a.r.t Column: Lack of Oversight and No Accountability

October 31, 2024

October 31, 2024

S.M.a.r.t. periodically invites guest columnists to write opinion articles on topics of particular interests to our readers. Below is an...

SM.a.r.t Column: “Help! I’ve Fallen, and I …!!”, Cries Santa Monica!

October 25, 2024

October 25, 2024

Maybe fallen, but slipping for sure from being a desirable beachfront community that served all equally, the local residents who...

SM.a.r.t. Column: Vote

October 13, 2024

October 13, 2024

In a polarized country or City every vote counts. Regardless of which side of any issue or candidate you support,...

SM.a.r.t Column: Fact-Checking Election-Season Windbaggery

October 6, 2024

October 6, 2024

Claim: The state is requiring Santa Monica to build 9,000 apartments.Answer: Partially true, partially false. Santa Monica has a pretty...

SM.a.r.t. Column: Public Safety and Traffic Enforcement Can Help Save Lives and Revitalize Santa Monica’s Economy

September 29, 2024

September 29, 2024

We wholeheartedly endorse the candidates below for Santa Monica City Council. Their leading campaign platform is for increased safety in...

SM.a.r.t Column: Crime in Santa Monica: A Growing Concern and the Need for Prioritizing Public Safety

September 22, 2024

September 22, 2024

By Michael Jolly Over the past six months, Santa Monica has experienced a concerning rise in crime, sparking heated discussions...

SM.a.r.t Column: Ten New Commandments

September 15, 2024

September 15, 2024

Starting last week,  the elementary school students of Louisiana will all face mandatory postings of the biblical Ten Commandments in...

SM.a.r.t Column: Santa Monica’s Next City Council

September 8, 2024

September 8, 2024

In the next general election, this November 5th, Santa Monica residents will be asked to vote their choices among an...

SM.a.r.t Column: Part II: The Affordability Crisis: Unmasking California’s RHNA Process and Its Role in Gentrification

September 2, 2024

September 2, 2024

Affordability: An Income and Available Asset Gap Issue, Not a Supply Issue (Last week’s article revealed how state mandates became...

SM.a.r.t Column: Part 1: The Affordability Crisis: Unmasking California’s RHNA Process and Its Role in Gentrification

August 26, 2024

August 26, 2024

In the world of economic policy, good intentions often pave the way to unintended consequences. Nowhere is this more evident...

SM.a.r.t Column: They Want to Build a Wall

August 18, 2024

August 18, 2024

Every once in a while, a topic arises that we had previously written about but doesn’t seem to go away....

SM.a.r.t Column: Sharks vs. Batteries – Part 5 of 5

August 11, 2024

August 11, 2024

This is the last SMart article in an expanding  5 part series about our City’s power, water, and food prospects....

SM.a.r.t Column: Your Home’s First Battery Is in Your Car

August 4, 2024

August 4, 2024

This is the fourth in a series of SM.a.r.t articles about food, water, and energy issues in Santa Monica. You...