Anyone who thinks our system is great is either: young and healthy, or old and rich. I saw a great saying the other day, that should be made into a bumpersticker: There are two types of Republicans – millionaires and suckers.

Once out, they realize that, in order to pay off their loans, they have to become a specialist or sub-specialist. Primary care jobs don’t pay very much (relatively) and, if you’re going to be thirty when you finally finish, and saddled with a few hundred thousand dollars worth of debt, you have to consider these things.

Back in my day, before the Reagan revoultion had run its course and wiped out every last vestige of progressivism in our government, there was a program that would allow new doctors to write off their medical schoool debt in exchange for working in primary care in underserved locations for a number of years. The program was a good one, and it worked. So of course it is no more.

Now many schools steer students to private lenders instead of government loans (kickbacks….), and there is no loan forgiveness. Are we surprised that medical students choose the beter paying specialties? Many would love to be in primary care, but just can’t realistically do it.

We need to put the honorable professionalism back into this system so that those who have a calling to serve the health needs of the sick and injured and frail will not simply be used by profiteers who could care less about the nobility of service to others.

Yesterday I wrote a post about the way our health care system is no longer capable of providing basic, primary care and emergency services to everyone who needs it. There are several causes for this, but the primary cause is that the “system” has b…

a) It’s what they do.

b) It’s all they do.

c) It’s starting to lose its luster.

After their Second Great Experiment (Prohibition being the first, and we all know how that one turned out) we once again have an opportunity to defuse their whining and just let them scream.

I would give a lot for one talking head, for one show, to counter their talking points with, “But you were wrong about that, and that, and that. Why should we listen to you now?”

Let me be clear that I am not suggesting we shortchange anyone who needs care. My favorite person is my 4 year-old daughter, and the preferred pediatrician is not an MD, but an ARPN, if I have the initials right. She’s a highly trained nurse with incredible empathic talents. She also knows what she does not know, so we will get bumped ‘up’ to an MD or specialist when needed.

While this ‘nurse’ caregiver is gifted, I do not think she’s even close to unique. I’m told that the floor nurse in a hospital will save patients from malpractice more often than we want to know. To put it simply, she saves the patient from the doctors screwups.

There are a lot of highly trained non-MDs who can handle a huge portion of the primary care work. They only need to be licensed and certified to do it, and trained to recognize when a situation requires the MD. IMO, doctors have held way too much ‘busy work’ that a competent RN could do.

We can’t even have consensus about the historical reality of bookbags and armbands? On college campuses in the 60s? Are they kidding? No wonder they can’t wrap their heads around the idea that the shortage of primary care doctors has been there all along, it’s just now distributed differently and therefore more obvious to them.

c u n d, imbecile is too polite a word for them.