Here’s an important segment of the social engineering component of the Affordable Care Act (ACA), passed under the Obama presidency:
The ACA provides a strong emphasis on preventive medicine and primary care through insurance reform, increased reimbursement for primary care providers, funding to educate these providers, and incentives to attract providers into primary care. The Nurse Practitioners (NPs) are especially well prepared to educate providers on the use of evidence-based preventive care and to assist the U.S. healthcare system in its transformation toward this model.
In other words, under the rubric of preventative medicine, millions of people who might not have gone to see a doctor prior to ACA are being encouraged to go. To meet the cost of those millions of new patients, new institutions like urgent care centers are springing up. Physicians’ Assistants (P.A.s) and Nurse Practitioners (N.P.s) are being used to treat these people as well as more serious cases. The medical schools do not turn out enough M.D.s to treat the 30 million people (new “patients”) who are being channeled into the American health care system. As my primary care doctor (an M.D.) told me, there is increasing pressure on him to have a practice of only very sick people. He frankly told me that he does not want the stress of treating only the very sick all day, every day.
So, in the post-ACA morass, we have too many people going to see M.D.s who don’t need an M.D. We have too many very sick people that have to wait a very long time to get an appointment with an M.D. And…we have increasing numbers of P.A.s and N.P.s supervising the care of very sick people. With millions of dollars pouring into the health care system from the federal government, it becomes a boon to hospital income to have less qualified personnel who need to be paid less than M.D.s. It’s a morass depicting itself as “needed reform.” From the Hippocratic Oath to do the least harm, the health care world has shifted to the “principle” see the most people and diminishing the quality of health care. There is a trade-off between the numbers served, which increases, and the quality of care and professionalism, which decreases.
Delusions of Adequacy 