This is not greed, it is just plain market capitalism. No one expects the star quarterback to accept a tenth of the salary just because some mediocre team would derive greater benefit from his presence than if he went with the high bidder.

As long as the backward economics in health care run counter to what makes the rest of our economy run efficiently we cannot expect a rational distribution of health care providers.

We bitch and moan about the price of gasoline right now, but the supply/demand setting a floating price has kept virtually every pump open. If you can recall the effects of rationed gasoline and price controlls of the 70′s it mirrors what happens in health care; lines, inefficient distribution, hoarding.

Why does the government not want market rates to apply? Because then medicare/medicaid would have to pay commensurate with private insurers. Government insured patients will never get optimal access as long as they are viewed as a cost liability for whom the provision of care is seen as a public service. Sure there is a tradition of charity in health care, but this ‘charity’ comes with onerous paperwork requirements, and the everpresent possibility of a government audit with the specter of prison and large fines if they don’t like the book-keeping. Try to limit the amoung of ‘charity’ so that one does not go financially bust and run afoul of more laws mandating this enforced ‘giving’.

Instead we will simply add to the growing number of specialists (75% of graduating residents), and Health Affairs printed an article last week proving that the more specialists, the higher the mortality rate at a county level. So producing more doctors may actually hurt the health of the population rather than help it. Either way it’ll cost society a hell of a lot more money.

Obviously you can add an extra person to a gross anatomy group, figure out something for the microscopes, and count on a crowded classroom for only the first few weeks until people stop going to class. But you still run into all sorts of other problems: too few computers in the library, not enough study space, overtaxed support staff, not enough lockers, for everyone, etc, etc. Some of the costs for increasing infrastructure will be covered by the $26,000 tuition those extra 24 students are paying each year, but if a school’s resources are already taxed, and significant improvements need to be made, the easy solution is to just increase tuition. Tuition increases can be problematic for those reaching the end of their loan limits, or and the amount of debt someone graduates with certainly influences career decisions.

So, what is the best solution? I honestly don’t know. Obviously some schools can absorb extra students more easily than others, but is that even a good solution to the problem?

“TALLAHASSEE, Fla. — Retired fisherman Billy Bodiford was diagnosed with prostate cancer in October. The doctor who found the cancer is the only urologist available in Taylor County, Fla. (pop. 19,200) — and he visits just one day a month.”

C’mon db !!!

Would YOU want your radical prostatectomy done in a hospital servicing a county of less than twenty thousand people?

Even if there WERE a urologist in that county, even if that hospital DID radical prostatectomies in that county, simple statistics would hold that the hospital would do them so rarely that you would not want that surgery done on you, or on someone you cared about, in that hospital.

You know d@mn well you would be the first on the road to Tallahassee if you were in that county…..and you would be recommending the same to your patients.

Sorry….I have no sympathy for those who get upset that they don’t have the Mayo Clinic in Jerkwater USA.

I live and practice in an area that small. It’s beautiful, so we get a lot of people who want to retire here. I have had many new patients who move here, despite major illness that requires tertiary care.

I mean ONGOING tertiary care.

I tell tham, they have no business moving here. Many have taken my advice and moved back to the big city, to be closer to the healthcare we won’t have a prayer of offering here. Some ignore me, but after a year of driving back and forth 100+ miles one-way to the University, they see the error of their ways.

Vish