Economics, job losses

Last week, I had the pleasure of watching the inauguration of our 44th president. I felt optimistic about our future, even though President Obama's speech was not full of the optimism he expressed during the campaign, rather full of realism. I know the economic disaster we have on our hands, as well as the diplomatic one, the wars we are fighting and some might say losing. Yet, I am basically a glass half-full kind of a person!

However, I am really starting to see the effects our economy. On the news this morning, there was more disturbing news about record job losses, record company closures, etc. In my community, there always seems to be a recession with few good-paying jobs, expensive gas and groceries, and a lot of elderly people with limited incomes. But now, we are seeing an influx of people from elsewhere in the country who have lost their jobs. They move here because housing is still inexpensive, and the weather is nice. I guess if you're going to be unemployed, at least it's nice to sit in the sunshine. But really, it's shocking to realize the numbers of people moving from industrial cities like Detroit, Minneapolis, Pittsburgh. The problem is that there are, like I said before, few good jobs.

I was speaking with a drug rep who survived large cuts at his company, only to be given a larger area of NM to cover. He is very grateful that he has a job, even if it means he doesn't see his family. I also now see several fathers in my clinic who are back home, having lost their jobs in the oil fields, suddenly becoming reacquainted with their wives and children, but jobless. I'm also seeing a rise in kids entering the military after high school because college is unaffordable.

It's just very different when you know people directly who are suffering from our economy, rather than only hearing about it on the news. I hope that our new president and congress can come together to create jobs, to improve education, and to improve our health care system. Sadly, I don't think there is a quick fix, even a great big economic stimulus package. I know that I'll just continue to take care of the families in the community; at least I can do that to a degree, whether they have health insurance or not!

New Year's Resolutions/Wishes

Happy New Year to everyone!! Now that the holidays are over and school is back in session, my life is returning to it's usual busy wintertime schedule. It's also the time of year when people discuss their resolutions for the new year, and I see a lot more people walking on the track after work! I've often been tempted to ask if they are there to lose weight in the new year, but instead I just see how many days they last...it seems that two weeks is about the maximum. All this aside, it's also a special January this year, as we will be inaugurating a new president in a few short weeks. I hope things will start to change quickly.

In light of the potential for change, I have come up with a list of my top 10 wishes for our health care system which I am hoping will be targeted for change early in this new administration. I know that some of these wishes are not free, and I don't know where the money will necessarily come from, but a wish is just that, a wish! I could also go on with many more wishes, but I think ten is a good start.

1. Renew and increase funding for SCHIP. Perhaps with more Democrats and more progressive Republicans in Congress, this will happen.

2. Increase reimbursement for pediatricians giving vaccines.

3. When considering universal health care, examine what other countries have done and perhaps create a system which combines the best from the different approaches being used world-wide. Having waited this long to do what most other first-world countries have already done, we might as well turn this to our advantage and learn from the mistakes of others.

4. We, as physicians, need to practice medicine responsibly. We need to accept that we are contributing to the skyrocketing costs of medical care in the US, and we need to do something about it.

5. Continue to encourage medical students to go into primary care with increased emphasis on programs that already exist, such as the National Health Service Corps. As costs for higher education continue to escalate and funding for student loans is cut, informing pre-med college students about the availability of scholarship programs may be more effective than in the past.

6. Continue to study pharmaceuticals specifically in the pediatric population.

7. Continue to promote the safety of vaccines. The American Academy of Pediatrics is working diligently on this effort.

8. Strive to continue research efforts with stem cells.

9. Provide adequate reimbursement for obesity counseling, nutrition education.

10. Let's get daily physical education back in schools!!

health care

Today, I was reading another physician blog, http://acountrydoctorwrites.wordpress.com/, in between seeing patients (my charts were calling but I ignored them for the moment). One of his recent stories was entitled, "Choices in Swedish Health Care." In it, he discusses the socialized system of medicine in Sweden, a system somewhat similar to other socialized ones. This topic has been on my mind lately, especially with the election looming in November. Perhaps I shouldn't use the word "looming," but I am very concerned that a president will be elected who has not even mentioned the word health care.





I spent one month working at a pediatric clinic/hospital in New Zealand in 2004, another country where everyone has basic health care. It is also somewhat tiered, in that there are some options for faster care through a private-payer system. One of the big problems there, as in Sweden, was waits. There is, however, a fairly strong medical tourism trade with Australia, especially for people needing radiation therapy for cancer; people who can afford to live temporarily in Australia are able to start their therapy more quickly. At the time I was there, these waits were being addressed by the government, so hopefully, things have improved.





However, as we all know in the US, many people go without health care due to lack of health insurance. And, even those with insurance risk bankruptcy with a diagnosis of cancer, or a chronic health problem. We spend the most on health care of any first-world country, yet we have the poorest outcomes. What gives? Is that our technology is so advanced that we try to save those who likely would die in other countries? Is that our fees in health care are completely out-of-line with the rest of the world that we are just simply paying/charging too much? Is it the fault of the drug companies who make enormous profits are drugs that cost too much? I suspect it's a combination of all these and other factors.



The bottom line, for me, is that if we, as a country, feel that health care is a right and not a privilege, we need to be willing to make sacrifices, to change how we as doctors are paid, and to change how we as consumers define health care.