AEIdeas

The public policy blog of the American Enterprise Institute

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Discussion: (23 comments)

  1. Hey Jon Murphy! What’s up with #4?

  2. PeakTrader

    “Concord, NH Wants to Spend $250,000 on a tank (armored police vehicle) to Use Against Occupiers and Libertarians. Yikes, that’s scary.”

    What’s even scarier is hiring a dozen cops at $70,000 a piece instead, with Cadillac health care plans and big pensions.

    1. PeakTrader

      “Use Against Occupiers and Libertarians.”

      An indirect and direct policy by the Obama Administration to make others pay unnecessarily.

      My favorite example is Cash-for-Clunkers, when the Obama Administration paid people with their own money to destroy their cars.

      1. PeakTrader

        And, of course, used car prices went through the roof.

      2. maybe it should have been “cash for armored police vehicles”, eh?

  3. Citizen Buddy

    #9), London panorama defines the word: panorama.

  4. Actually the Nurse Practicioner piece leads to an interesting thought, why not allow foreign medical graduates to practice as NPs for a couple of years to prove themselves? I would suspect that a foreign medical school should provide as much education as a NP gets. Dont require the long residencies that are currently required, or perhaps make the NP slot the equivalent of a residency.
    After all if you think about it modern physicians are overqualified for a significant part of their patient load, the article suggests it could be as high as 90% of the patient load. If you define the limits and encourage referrals for had cases to a physician you can reduce the load for more simple issues.

    1. Lyle, why don’t you write to the AMA with your suggestions?

      1. Write to the guild that protects physicians from competition? They are the ones that lobby to set the rules that prevent competition from the non physicians. They concentrate on the edge cases in their arguements, yet you see instances where the first physician can’t figure out what is wrong either. The AMA IMHO is nothing but a guild in the Medieval mold protecting physicians from competition, another example is that in Europe in many cases pharmacists can prescribe some medications directly, (after all its a 4 year program after 2-3 years of undergrad school), so they have a good bit of training, why not allow them to do as in Europe, but no the Physicians guild does not want that competition.

        1. Lyle, that’s why I suggested you write to them. The rules and requirements are all those of the AMA, and only they can change them. I don’t think you will find many commenters here who disagree with you on this subject.

    2. Citizen Buddy

      “After all if you think about it modern physicians are overqualified for a significant part of their patient load…”

      Lyle, if you have a medical concern do you want to be evaluated by someone who could be under qualified or over qualified?

      I go with over qualified.

      1. I have a choice of seeing the nurse practitioner right away or the Dr. in a couple of days.

        No problem. If the NP thinks the Doc should take a look, usually see her right then.. no appointment..

        if not.. the NP takes care of the problem. I can always set an appointment if I prefer.

        It makes perfect sense. They do something similar at eye clinics, auto repair, even ERs…..

        1. My point of view exactly, see someone sooner for a bit longer, and if the problem is beyond the NP’s scope of authority refer it, just like physicians do already with many issues and refer to specialists.

      2. I go with over qualified.

        Cit, I go with the baby bear level of qualification – the one that is *just right*.

        I want someone who is qualified to address my minor problem themselves, and direct my more serious problems to the right expert. In my experience NPs are that person.

        1. morganovich

          “Lyle, if you have a medical concern do you want to be evaluated by someone who could be under qualified or over qualified?”

          this seems like a false choice.

          how about “sufficiently qualified”?

          if you want to paint the ceiling in your kitchen, you could hire bob’s painting or michaelangelo. sure, mike is more qualified, but is the extra price and wait really worth it?

          if i am having brain surgery, hell yes, i am going to look for the best guy i can find and will be willing to pay up for it.

          but if i need a throat culture taken and tested for strep or some stitches on a cut on my leg, well, i’d be willing to go with far more folks.

          an md taking a throat swab is like using a caterpillar mining truck to move your couch.

          it’s overkill and costs far too much for no additional benefit.

          why not just use the right tool for the job?

        2. Citizen Buddy

          Ron, you are right that NPs are right for “minor problem” triage. A scraped knee and a headache from falling off your long skateboard? Hot water, antiseptic, a large Band-Aid and pain killer prescribed by the NP. The minor is the knee scrape but the major could be the headache.

          Who judges that the qualification is ” ‘ just right ‘ ” for the problem at hand?

          I am skeptical that effectiveness studies of NPs look at the consequences of NPs, that take on too much in treating medical problems.

          1. Cit

            Who judges that the qualification is ” ‘ just right ‘ ” for the problem at hand?

            Initially, I do. I might judge myself qualified to treat my own scraped knee, for example. A headache could result from serious head injury, and again my own evaluation and monitoring of my own symptoms would be a good starting point. If I concerned that further evaluation might be indicated, I would seek treatment from a healthcare professional, perhaps an NP, who could provide additional diagnosis, testing, x-rays or imaging, and referral to a specialist.

            You may be underestimating the qualifications and expertise of NPs, who in some cases are basically doctors without the credentials or authority. In fact some of the best medical treatment I’ve received has been from NPs, who seem to work harder at problem determination and resolution than some of the doctors I’ve visited.

            For anyone who provides medical treatment, including doctors, it’s necessary that they understand and acknowledge when something may require additional specialized diagnosis and treatment.

            In my experience NPs are very good at making that determination.

            I am skeptical that effectiveness studies of NPs look at the consequences of NPs, that take on too much in treating medical problems..”

            Why would that be a problem unique to NPs?

            Maybe I don’t understand the word “effectiveness”, which in my view would be a measure of correct diagnoses and outcomes vs incorrect diagnoses and outcomes.

          2. NPs are more than capable at triage… and the way that some NPs work.. you see them right away and if you are not satisfied then you sign up for the doc.

            but the NP or Doc have knowledge that most of us don’t have and a NP is likely more capable than us in determining the initial diagnosis – which is always subject to a second look by the Doc.

            they do the same exact approach when you get wheeled into an ER unconscious….it’s an appropriate allocation of resources and as the customer you always have the right and ability to pay for more/better.

          3. morganovich

            cb-

            “Who judges that the qualification is ” ‘ just right ‘ ” for the problem at hand? ”

            the customer does, just as he/she would choose the car, power tool, home, or shampoo that best seems to meet their needs.

            no one is saying you can’t go see a doctor is you feel it’s necessary. they are just saying you ought to have more choices. choice is good.

  5. what a relief! I thought the Concord Police were getting ready to rebuff ObamaCare… or the IRS…

    ;-)

  6. Blue Collartrader

    Housing affordability at a three year low? Ooooh, reinflate those housing bubbles! How long before the gub’ment starts relaxing lending standards to “Help” this along? This type of story should make people nervous, not enthusiastic.

  7. Regarding #5, how would you respond to someone telling you that increasing MPG is due to “nugding” in the form of CAFE standards and MPG-targets imposed by the executive branch? Manufacturers wouldn’t have any incentive to improve gas mileage if not for legislators getting tough on them. How can you be sure “things will get better all the time” without those rules in place?

    (I have my own thoughts, just playing devil’s advocate here.)

    1. actually CAFE standards usually require Congress.

      but some people the unfettered free market without “interference” from the govt would produce what consumers value and that the govt by imposing CAFE standards is screwing up the free market.

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