If you are a regular reader of this blog, you know:

1. The U.S. federal government is Monetarily Sovereign. It has the infinite ability to create its sovereign currency, the U.S. dollar. It never can run short of dollars.
2. It can pay any financial obligation regardless of size, without levying taxes, merely by touching computer keys.
3. Contrary to popular belief, federal spending is financed by creating new money rather than taxpayer funds. When federal taxes are collected, they are effectively destroyed. Federal “debt” does not represent a financial burden on the federal government or taxpayers.
4. Federal spending does not cause inflation. Shortages of critical goods and services — usually food, water, and employees — cause inflation. Federal spending cures inflation when it addresses these shortages,

Please keep these facts in mind as we discuss excerpts from an article in the January-February edition of the AARP Bulletin:

By Howard Zucker*:

“How can I find a doctor who can help me?” As a physician, I get this question from friends and family all the time. And for most of my professional life, I was able to refer them to a medical colleague; a simple phone call was all it took to get someone an appointment within a reasonable amount of time. But no longer. The average wait for new patients to see a physician is 26 days, and that’s for mostly healthy people. In a medical emergency, the situation can become even more frightening: Twenty-two percent of acutely ill patients 65 or older who sought medical attention had to wait six days or more for an appointment, according to a 2021 survey by the Commonwealth Fund. This is a crisis. And it’s a crisis that’s getting worse, rapidly. “The backbone of our health care system, private practice, is on the brink of collapse,” warns Clarel Antoine, M.D., professor of obstetrics and gynecology at New York City’s NYU Grossman School of Medicine. “The nearly 70 million Americans on Medicare, many with chronic conditions, can expect longer waiting times for medical care.” Although there were some 835,000 practicing doctors in America in 2023, according to the U.S. Bureau of Labor Statistics, we are currently experiencing a shortage because demand exceeds supply. The current shortage of physicians, combined with a number of other factors, has placed such an intense strain on doctors that many in the medical field are choosing to switch professions or simply retire early. And despite efforts by the Association of American Medical Colleges (AAMC) to graduate more doctors, those efforts simply can’t keep up with the drain. Why don’t we have enough doctors? In 1980, a U.S. government report concluded that American teaching hospitals were graduating too many medical students. It predicted a surplus of 70,000 physicians by 1990, an alarming statistic. In response, medical schools established what became a 25-year moratorium on increasing class size, enforced by the AAMC and the American Medical Association (AMA). Yet there was a significant flaw to that initial report: It failed to account for the nation’s rising population, which is now 110 million more than it was 45 years ago. By 2005, as the population grew and the potential for a severe physician shortage emerged, the AAMC and AMA reversed their recommendation, and in the past 20 years, more and more young people have trained to be doctors. Yet despite the more than 97,900 students in medical school, 38,000 in osteopathic school, and 162,000 doctors currently in residencies and fellowships, the AAMC predicts a shortage of up to 86,000 physicians by 2036. By then, it projects that the U.S. population will have risen 8.4 percent since 2021. The population of those over 65 will increase by 34 percent, while the number of people 75 and older will increase by 55 percent. “Medical education is a long journey, and even though medical school enrollment has risen, we need more residency positions [where med school graduates get hands-on training], which requires increased government support,” says David Skorton, M.D., president of the AAMC. It’s not just that we don’t have enough doctors. Part of the problem may be that we don’t have enough of the right kind of doctors. Becoming a doctor is expensive: The average medical student emerges with roughly $235,000 in debt.

There is no reason for this. Our Monetarily Sovereign federal government easily could fund medical school education for everyone who wanted one without collecting a penny in taxes.

Now consider that the average primary care physician (PCP) in internal medicine, geriatrics, pediatrics or family medicine makes about $250,000 to $275,000 a year.

Not nearly enough to pay off his/her loans.

Becoming a PCP just isn’t financially feasible for most recent graduates. Two-thirds of newly minted doctors are choosing to become specialists, which allows them to earn salaries upwards of twice what a primary care doctor can make. “Primary care physicians are undervalued by government and insurance companies, and that is reflected in decreased compensation,” says Isaac Opole, M.D., president of the American College of Physicians. “It makes the field unattractive to medical students.” Yet it is the PCP who provides the annual checkups that may detect problems early on, and who serves as the gatekeeper for referrals to specialists. Many people with private insurance, as well as those enrolled in Affordable Care Act plans, are required to see a PCP before they can access specialists in a majority of fields. And while many med students are choosing to go into specialty care, others opt not to become physicians at all. Indeed, more than 50 percent of medical students and residents surveyed preferred to pursue careers that do not involve direct patient care, such as research or teaching, according to a 2023 report from Elsevier Health. One in 4 contemplate dropping out of medical school altogether, citing overwork, financial stress and mental health concerns. In a study published in 2019, parts of chromosomes that shorten with age eroded six times faster than average for doctors in their first year of training after medical school; researchers attributed the accelerated aging to the doctors’ stress levels.

Why your doctor doesn’t have time for you Many doctors dreamed of medicine as a profession from early childhood. In past generations, it was common to see physicians practicing long past the age when they could retire. Yet a recent AMA survey found that 1 in 5 doctors were hoping to find a way out of medicine in the next two years. Among those 55 or older, that figure was 1 in 2. Why? Part of what’s driving this is the growing trend of private equity firms and corporations, such as CVS Health and Amazon, purchasing hospitals and private practices. One major medical group, with about 90,000 doctors in some 2,000 locations across the country, has spent billions of dollars acquiring physician-owned practices, home health centers and surgical centers. This past April, the Physician Advocacy Institute reported that just shy of 80 percent of all doctors were employed by hospitals or corporations, up 200 percent in just over 10 years. Typically, when for-profit firms acquire practices, they approach these acquisitions utilizing a profit-based strategy. What does that look like? Corporate entities now govern doctors’ allotted time with patients, often allowing just 15 minutes per visit, a situation that isn’t healthy for either the doctor or the patient. “They control every aspect of a doctor’s professional life, and it’s all about the money,” one doctor told me. A 2024 JAMA Internal Medicine report said that 61 percent of doctors surveyed found private equity ownership unfavorable for health care. For every hour seeing patients, the average doctor now spends two hours doing administrative tasks, according to the AMA. A primary driver of paperwork: the electronic health record, or EHR.

“The EHR is the bane of existence for every doctor in the country,” says Opole. The EHR was designed to eliminate a paper-based tracking system and make patients’ health records easier for various health professionals to access. But in practice, doctors say, its primary focus is documenting for regulators and billing for insurers. To handle rising administrative demands, doctors have begun cutting back on office hours, resulting in even less time available to see patients. A 2023 Mayo Clinic study noted that 40 percent of doctors it surveyed intended to reduce their work hours in the coming 12 months.

The federal government could and should fund non-medical, administrative support help for doctors without collecting a penny in taxes.

“The doctor-patient relationship requires time to establish a trust, which comes with patients sharing stories of their life with you as it relates to their health,” John Dooley, M.D., an internist in private practice in Washington, D.C., shared with me one evening while driving home at 9:30 p.m. from a grueling day of work. “That doesn’t happen if you only give them 15 minutes.” Every physician told me they are burned out. Simply put, they are being asked by the business world that owns their practices to do medicine, at times, in ways they view as not in the patient’s best interest. Meanwhile, those who cling to their independent practices are finding it impossible to hold on given the financial pressures on them.

The government could pay doctors more. After all, one good doctor is worth more to America than a score of Elon Musks.

Yet another troubling trend: More than 300 doctors now die every year from suicide, a rate twice that of the general population. “We take highly intelligent people with a calling, put them in a demanding and often hostile work environment without any reasonable labor protections, and they cannot even meet their basic needs,” says Pam Wible, M.D., who runs suicide-prevention workshops for physicians. “They can find themselves on the path to taking their own life.” At a recent visit, my own primary care doctor, Paul Arias, M.D., shared that “the pandemic drove many doctors into retirement; others became ill and required disability and, sadly, some died. For those who remain, many fight daily with insurance companies to get approvals for a patient’s labs or procedure. It’s exhausting. Corporate America has taken over medicine.”

And yet, the Republican Party wants to privatize Medicare so that insurance companies can make more money and provide worse service.

To increase revenue, reduce paperwork and regain control of their lives, more and more doctors are choosing concierge medicine, a system in which patients pay a yearly out-of-pocket fee in exchange for longer visits and shorter wait times. Costs can range from $2,000 to $10,000 annually, though some practices have upfront prices that are markedly higher. And since most Americans don’t have the financial resources to pay such high and nonreimbursable fees, this further drains the pool of doctors available, especially to older people on fixed incomes.

I have a concierge doctor. My previous doctor served more than 2,500 patients. Wait times were long, but visits were short. My concierge doctor has about 500 patients. I can see her on a moment’s notice, and we spend at least a half-hour discussing my medical situation, often far more than a half-hour. She knows me far better than my previous doctor ever could. Concierge is the private sector’s solution to the federal government’s failure to do what it could easily do: Pay doctors more and pay for their non-medical assistance. It’s not a good solution, however, because if protects only those who can afford the service fee. It reminds me of the private sector’s poor solution to Medicare’s failure to fund everything medical: Medicare Advantage. This partially private-sector-funded program is famous for requiring advance notice of medical procedures, dramatically reducing the number of procedures authorized. Americans suffer needlessly when medical service is restricted by the ability to pay and the profit motive. It is disgraceful that America, which could afford the best medical care, has mediocre to poor care.

“There is a perfect storm coming,” says Bruce Scott, M.D., president of the AMA, “with increased patient complexity, decreased reimbursements and increased demand for prior authorizations from the insurance company. The combination of these makes it increasingly difficult for physicians to accept new patients and, in some cases, even keep their doors open. We can’t afford to lose even one more doctor.”

And now the real embarrassment: Advice on how to jump the line:

To ensure you get the care you need:

1. Become friends with the nurses or schedulers in the doctor’s office. Learn their names and make sure they know yours. They can let you know if a cancellation has occurred and keep your name on a waiting list.
2. Schedule your next appointment while you are at your current one. That’s your best shot at securing a spot on the calendar.
3. Make sure to fill out all health forms online in advance of your visit. You may have only the smallest of windows to talk with a provider, so make sure you’ve provided as much information as possible to maximize your time in the doctor’s office.
4. Ask about telehealth options. If the physician’s practice cannot see you in the office, speak with the scheduler to see if a telehealth visit is possible. In surveys, about 87 percent of doctors reported using telemedicine, but only 37 percent of adult patients had taken advantage of it within the previous 12 months, according to CDC data.
5. Or ask if one of your doctor’s colleagues or another provider in the practice can see you.
6. Ask your doctor for a referral — and to reach out on your behalf. If your doctor is retiring, moving or turning to concierge medicine, and following them is not an option, ask them for a referral. If they can recommend someone else in their group, even better — that comes with the advantage of your medical records being readily available.
7. And always check to see if that new physician accepts your insurance, including Medicare.
8. Ask your insurance company for a list of names of physicians. If you are on Medicare, go to Medicare.gov and click on the Providers & Services tab to find and compare doctors by location. You may want to consider a physician who is not geographically convenient to your home but who meets your other needs.
9. Don’t be shy about going to urgent care or the ER if necessary. In many cases it’s better to get someone to look at you today than to wait weeks for your regular doctor.
10. Monitor your health at home. Learn more about home care devices that can help to detect important changes in your health, such as a blood glucose monitor, pulse oximeter (to measure oxygen levels), blood pressure monitor, or electrocardiogram (ECG) to track heart rhythms. Calling a doctor’s office to report a change in a vital sign can speed up an appointment, give you some worthwhile reassurance — or urge you to get to an emergency room.
11. Do some research. Use the internet wisely. Physician reviews may not be particularly helpful, as they are not only subjective but often filled with complaints; satisfied customers are less likely to post reviews. What is useful, however, are a physician’s board certification, specialty training, insurance plans and hospital affiliations. 

*Howard Zucker is board-certified in six medical specialties. He has served as U.S. deputy assistant secretary of health, New York State commissioner of health, assistant director-general of the World Health Organization, and as a deputy director at the Centers for Disease Control and Prevention.

Those eleven suggestions just “shuffle the deck. They do not improve overall care. Jumping the line doesn’t make the line shorter. America has become so wedded to the false notion that the private sector is always superior to the government we tend to forget some important points:

1. Government workers are no different from private sector workers. Some are smart, hard workers;  some are not. As groups, they are the same
2. The federal government has the infinite ability to risk money for unprofitable research and development.  Only the federal government could have funded putting a man on the moon, and it continues to fund work by private companies like SpaceX.
3. Government spending adds to economic growth. The formula for Gross Domestic Product is: GDP=Federal Spending+Non-federal spending+Net Exports.
4. The profit motive causes some of the worst aspects of America’s healthcare system, like unreasonable refusals to pay medical claims.

Sadly, our political leaders act as though federal money is limited. So currently, Millions of Americans suffer and die too early because Congress does not understand Monetary Sovereignty. Here is what a knowledgeable and caring Congress would do with the infinite dollars it has available to spend without levying taxes.

1. Offer a free, comprehensive, no-deductible Medicare plan to every person in America, regardless of age or income. It would support every aspect of healthcare, including dental, eye, exercise, and personal training. There would no longer be different plans because one plan would cover everything.*
2. Fund free education and training for everyone who wants to become a doctor or nurse.
3. Fund research and development of medications and treatments for all diseases, including rare diseases that otherwise may be unprofitable for pharmaceutical companies.
4. In exchange for federal support, pharmaceutical companies would receive limited patent protection on medicines.
5. Federal support for doctors so that the concierge system no longer would be financially attractive.

*Currently, Medicare doesn’t cover:

1. • Custodial Care: Long-term care services, such as nursing home care or home health aide services, are not covered.
   • Routine Physical Checkups: Regular physical exams and certain preventive services are covered, but routine checkups are not.
   • Dental Services
   • Eye Examinations and Eyeglasses
   • Hearing Aids and Examinations
   • Cosmetic Surgery: Procedures that are not medically necessary, such as cosmetic surgery, are not covered.
   • Chiropractor Services: Chiropractic care is generally not covered unless part of a treatment plan for a specific medical condition.
   • Certain Immunizations: Some immunizations are covered, but others, such as travel vaccines, are not.
   •  Hospital services exceeding Medicare length-of-stay limitations:

• • • Days 1-60: Medicare covers the full approved amount after you’ve paid the deductible. For 2025, the deductible is $1,676.
    • Days 61-90: You pay a daily coinsurance of $419.
    • Hospital services exceeding Medicare length-of-stay limitations.
    • Days 91-150: These are called “lifetime reserve days,” and you pay a higher daily coinsurance of $838 per day. You have 60 lifetime reserve days that can be used during your lifetime.
    • After 150 days: You are responsible for all costs.

To see the dozens of medically related problems and procedures Medicare doesn’t cover, see here. Why doesn’t Medicare cover the above, especially when some are covered by Medicare Advantage and some private insurers? The answer: To save money. But Medicare, as a federal agency, doesn’t need to save money. It is funded by the federal government (not by FICA), which has infinite money. This is a clear example of our Monetarily Sovereign federal government pretending it is monetarily non-sovereign. SUMMARY Not only is the US short of doctors and nurses, but astoundingly:

U.S. ranks last in health care compared with nine other high-income countries, report finds. People in the U.S. die the youngest and experience the most avoidable deaths, despite spending much more on health care. The U.S. ranks as the worst performer among 10 developed nations in critical areas of health care, including preventing deaths, access (mainly because of high cost) and guaranteeing quality treatment for everyone, regardless of gender, income or geographic location, according to the report, published Thursday by The Commonwealth Fund, an independent research group.   The researchers looked at how the U.S. compared with nine other countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland and the United Kingdom. Each country was graded on five categories: access to care, care process, administrative efficiency, equity and health outcomes.

The Trump administration’s solution to the problem is to fire as many government workers as possible (Elon Musk’s Department of Government Efficiency (DOGE)) to save the government money, not to save the public money or to improve health care for the populace.

  Rodger Malcolm Mitchell Monetary Sovereignty Twitter: @rodgermitchell Search #monetarysovereignty Facebook: Rodger Malcolm Mitchell; MUCK RACK: https://muckrack.com/rodger-malcolm-mitchell; https://www.academia.edu/

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The Sole Purpose of Government Is to Improve and Protect the Lives of the People.

MONETARY SOVEREIGNTY