There is on the one hand, substantial evidence that this country receives too much health care. About 30 percent of the care we get is wasted. It's possibly harmful. It's definitely expensive. On the other hand, you hear a lot about our shortage of physicians and nurses. But we know that doctors create demand for health care. If you didn't know, then read Jason Sharfin's quick round-up of the evidence. The more doctors in your area, the more care you're going to receive. And you generally won't be any better off for it. You'll just be poorer.Added together, that's a bit strange: It's like saying we have too few people selling a product that we have too much of. But broken down a bit, it's not that strange at all. We have too many specialists and not enough primary care physicians. Specialists are expensive and tend to recommend expensive treatments. As the Dartmouth Atlas Project has found, "more specialists per capita in an area is associated with higher surgery rates and higher procedure rates." It is not, however, associated with better outcomes. This gets to a point I'm going to make at greater length in the near future, but one quiet element to watch in health reform is that this country can afford universal primary care-based health care. It cannot afford universal specialist-based heath care. But specialist-based health care has a stronger set of political lobbies and is far more attractive to doctors. TOO MANY DOCTORS?
There is on the one hand, substantial evidence that this country receives too much health care. About 30 percent of the care we get is wasted. It's possibly harmful. It's definitely expensive. On the other hand, you hear a lot about our shortage of physicians and nurses. But we know that doctors create demand for health care. If you didn't know, then read Jason Sharfin's quick round-up of the evidence. The more doctors in your area, the more care you're going to receive. And you generally won't be any better off for it. You'll just be poorer.Added together, that's a bit strange: It's like saying we have too few people selling a product that we have too much of. But broken down a bit, it's not that strange at all. We have too many specialists and not enough primary care physicians. Specialists are expensive and tend to recommend expensive treatments. As the Dartmouth Atlas Project has found, "more specialists per capita in an area is associated with higher surgery rates and higher procedure rates." It is not, however, associated with better outcomes. This gets to a point I'm going to make at greater length in the near future, but one quiet element to watch in health reform is that this country can afford universal primary care-based health care. It cannot afford universal specialist-based heath care. But specialist-based health care has a stronger set of political lobbies and is far more attractive to doctors. 
