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A health-care solution - Martha Carr

The health-care package authored by the Obama administration will make it possible for more than 31 million previously uninsured Americans to receive more consistent medical coverage. Aging baby boomers, who use, on average, twice the amount of health care of younger Americans, will be able to take care of chronic illnesses sooner, and increase not only their life expectancy, but their quality of life.

Parents will be able to stop trying to decide if there's enough money to take care of themselves or put food on the table and gas in the car.

Potentially millions of dollars can be saved in the future because of ongoing medical care, instead of rushed trips to a hospital's already overcrowded emergency room with a medical problem that's gotten complicated and harder to solve.

Getting enough medical care as it's needed will be one less thing that has people staring at the ceiling at night wondering how they'll cope, if an unexpected illness or accident happens to them or their loved ones. That's a nice story, but there's a giant hole.

All across the U.S. there are localities both rural and urban that have a shortage of doctors, especially primary care physicians or family doctors. There are several reasons to explain how we got here, starting with the 1997 Balanced Budget Act that capped the number of primary care residencies the government would fund. There is also the dilemma of Medicare payments to family physicians that have become paltry, driving many doctors from the profession altogether.

The need for primary care physicians is expected to increase by 22 percent by the year 2020, while the number of doctors will only increase by 18 percent, according to the U.S. Department of Health and Human Services, further exacerbating the problem.

The Obama administration has proposed increasing the Medicare payments to family physicians by decreasing the payments to specialized doctors, who are lobbying against that effort, saying it would decrease the availability of such operations as hip replacements or pacemakers. An aging population would probably agree with that argument.

However, unless we're willing to borrow more money from China or print more currency and risk the backlash of inflation we can't keep fattening the budget. There are consequences for everything.

There is a proposal by the National Council of State Boards of Nursing, www.NCSBN.org, to standardize the licensing for the more than 267,000 advanced practice registered nurses (APRNs) in the U.S., which includes certified registered nurse anesthetists, certified nurse-midwives, clinical nurse specialists and certified nurse practitioners.

Right now, the regulations surrounding APRNs varies from state to state, hampering their ability to move where there's a need, and in some jurisdictions, restricting them from providing basic medical care without the direct supervision of doctors. But, in areas where APRNs are able to fill the gap, there is an increase in patient care without any notice of patient harm.

"The ability of APRNs to provide safe, cost-effective, high-quality care is well documented in many studies over the past 30 years," said NCSBN President Myra Broadway. Many APRNs have expressed an interest in moving to the localities lacking physicians, but are hamstrung by the local legislation. Trying to change the state policies, one by one, would take more time and an army of people, and end up being a drain on resources that could go elsewhere.

NCSBN proposes a much saner national plan that would not only clear the way to solve a critical problem, but do so without having to take money from one deserving medical group to try and pay another, or without raising the federal budget even further into the red ink. The framework of dedicated nurses is already in place and all that's needed is the regulation and licensing to oversee the practitioners.

Regular testing and education are also a part of the proposed legislation to ensure that public safety is never at risk. More detailed information on the proposal is available at www.NCSBN.org.

Most often the easiest solution is to use what's already available, but somewhat overlooked, and this time, there's even a way to do it safely and cost-effectively. Now, we need Congress to pick up the banner.

Tweet me @MarthaRandolph to let me know what you think of the health-care proposal. www.martharandolphcarr.com.

E-mail Martha at Martha@caglecartoons.com. Martha's column is distributed exclusively by Cagle Cartoons Inc., newspaper syndicate.