Wednesday, May 27, 2015

One of the ways that many progressive states are actually progressive - empowering Nurse Practitioners

Now at least 21 states are undermining the MD Monopoly that our fearless Federal Government has tended so carefully since 1980 when Jimmy Carter and his Kool Kats handed it to an AMA that was already richer than Dallas. They are doing so by allowing graduate level Nurses known as Nurse Practitioners to provide primary care to patients without a monopolist - I mean an MD's - direct, avaricious supervision.

Despite this "progressive" innovation of Federalism, most progressives want to further empower that Federal State Who Sees and Rules Everything even though it would crush decent and honorable bits of progressivism like this. There's no accounting for liberal taste.

Note that states that have innovated in using Nurse Practitioners tend to be states with isolated, underserved communities.  States with huge numbers of doctors moving there and wanting to practice like FL, CA or TX are retrograde.  Also note that Obamacare makes no real provision for diverse state by state needs but imposes a national norm of corporatist control on healthcare provision.  Indeed it even makes the situation worse by penalizing independent doctor practices through underpayment the better to force them to sell to the bloated "Health System" duopolies that tend to dominate almost all communities not dominated by state sponsored "Health System" monopolies.

The way to think about "health systems" in your community is to imagine that instead of establishing national chains Walmart and Target remained only in your metro and acquired every kind of retail distribution outlet that existed until the two of them controlled 80% of the market.  Gas stations, mail order shops, difficult bra problem shops, gourmet restaurants, you name it.  Then imagine that the law protected the managers of each shop from active supervision by the conglomerate and the shop managers had the powerful American Shop Managers Association to advocate for their position in Congress and State Legislatures. Absent a market that strips even the privileged of their protections via market price and volume signals the management problem of the duopoly is insurmountable.  No management control, no cost control, no scale economies, no experience curves - almost nothing.  A true nightmare.  And the nightmare that we have and that has been massively strengthened via reimbursement subsidies by the corporatists that rule us.

Oh and did you hear?  O'care Healthplan 2014 year loss ratios are starting to come out very negative implying major rate increases - or plan shut downs. Surprise, surprise, surprise.  I think it's great that Progressives are learning the economics that they slept through in College.  It's just that the rest of us are paying the tuition.

Addendum: I forgot to mention that impeccably blue metros still (red states ditched these years ago) have the wonderful Federal innovation of "Health Facilities Review Boards" created by the Poindexters on the theory that more competition drives up prices (where the left gets the notion that they're braniacs is beyond me). And as per my example above, the most influential and active members of the local Boards to Supress Competition will almost always be reps from the local duopoly who are of course acting "in the best interests of the community".

It's corporatist fraud from sea to shining sea.

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