It would stand to reason that primary care physicians would have more work than they could handle if their practices were located where there is a significant population of elders. It would seem to me that practices like that would have a license to print money. Not so, with fewer physicians serving more patients, our primary care docs are burning out. And one of the problems is that the workforce isn’t replenishing itself fast enough. Docs, nurses, techs, and assistants are all in demand and are the backbone to rural care.
Last week, in a stunning announcement, the U.S. Department of Education (Or, what’s left of it), told Americans that RN nurses were no longer a professional degree. Justification for this decision was to limit the amount of money that could be borrowed for their education. Also, it shortened the training needed to be a nurse. I understand that these moves “might” improve access to care. However, when you treat a profession like a trade and place the emphasis on churning out barely-qualified workers, there is no doubt in my mind that the quality of that care will be diminished. Besides, without Bachelor’s or Master’s Degrees in nursing, we no longer have nurse practitioners, physician assistants, and the nursing educators needed to train the highly skilled nurses we depend on.
Right now, the regulator, Green Mountain Care Board, is struggling to balance the needs of our increasingly insolvent hospitals and health centers with the insatiable appetite of the insurance companies for our healthcare dollars. Changes at the federal level are making this tightrope walk even more precarious. Failure will limit access to care for Vermonters. Period!
One clear indication of the rough sledding ahead is the disappearing act by the Medicare Advantage programs in the state…I think there’s just one left now. Not even Blue Cross Blue Shield of Vermont wants to participate in the Medicare Advantage federal fraud-for-all program. The reason is really very simple: Basically, there is too much care required for our aging population, and even with the up-coding shenanigans, it would seem there are easier pickings elsewhere.
Each week, we hear of another hospital closing down various units, the most prevalent of which are birthing units. I get that fewer babies are being born, and it may not be cost-effective to keep birthing units open and staffed during periods when the unit is empty, but babies come at a moment’s notice. One unintended consequence of this strategy is that more babies will be born in the back seat of cars instead of hospitals. Perhaps this should be a new training opportunity for fathers at birthing classes. Why leave your newborn baby in the hands of a trained professional when DIY daddy can do it parked on the side of the interstate?
People are already seeing the results of Republican legislation from Washington, D.C., in the disappearance of the Obamacare subsidies put in place during the pandemic. You’d think that those that would scream the loudest would be the health insurance companies that get the subsidies, but no, subsidies or not, the insurance rates are set, and you’re paying one way or the other, or doing without. Of course, they will lose customers, and the first to leave will be the younger and healthier who pay premiums for a product that they find they don’t use. It’s those ratepayers who help make health insurance affordable for the rest of us.
What’s soon to happen is that an incomprehensible sum of money is going to be removed by the federal government from healthcare, and our house of cards healthcare system will collapse from its own weight. We’re seeing it now as smaller clinics are closing or limiting services. With larger hospitals showing signs of stress and federal money being repurposed, we’ve got no choice but to find another way.
After our experience during the COVID-19 pandemic, we understood that our hospitals need to be available for huge catastrophic events. The problem is the same as with the birthing units: It’s not needed until it’s needed. What we as a people have to decide is how much we are willing to invest in units that are lying in wait. The question that should be asked is “Is this investment in the public good?”
We all know that to have functioning full-service hospitals nearby is in the public good. We also know the current system is failing us. I can think of no more important issue facing Vermonters than our healthcare. In the last half of the biennium, our lawmakers need to find a solution to our dwindling rural care. Proposals in the past have been spot on: Universal primary care (the docs will flock to Vermont), and universal hospital care that will all but eliminate the uncompensated care that’s helping hospitals into the red zone. Lawmakers need to either pull the Band-Aid off and take on the insurance industry, or get the hell out of the way of those who will.
Contact Kurt Staudter at staudter@sover.net.