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To: re3 who wrote (20168)	9/20/2000 7:28:21 PM
From: patron_anejo_por_favor	Read Replies (2) \| Respond to of 436258

Nice take in The Rap tonight about Patron's second favorite topic, health care inflation: As a cardiologist, I can verify the evolving nursing shortage, and such wage (and supply) pressures on hospitals are increasing. With regard to your reports of skyrocketing health insurance premiums, things may only get worse. Boomers, at the cusp of the expensive maladies of aging such as heart disease, face a shortage of cardiologists and other specialists quietly, but rapidly, developing. We are now trying to recruit cardiologists with little success. Only 5 years ago they were a dime a dozen. Clumsy government attempts to decrease high-cost specialty care have forced residency programs to curtail training. Even at the medical school level, physician supply is dwindling. . . the specter of decreasing pay, lifelong 100 hour workweeks, loss of control in patient care (but with all the responsibility and culpability), and the increasingly successful trial lawyers "malpractice" extortion all taking their toll. Hospitals, already under extreme and under-appreciated financial stress from cutbacks in the Medicare system due to the balanced budget act of 1997, may be forced to pay a premium for remaining specialists, probably less willing to inflict unethical HMO "reverse incentives" on savvy medical consumers in the next decade, when cardiac illness may increase fourfold. The government "surplus" figures will further erode if a cascade of hospital bankruptcies ensues, not as far-fetched as it sounds, and the public realizes the extent to which medical care in the U.S. is dependent on this entitlement program. The writing is on the wall: substantial increases in hospital costs, physician and nursing labor and insurance premiums, coupled with markedly increased government spending, versus dramatic cutbacks in the scope and quality of care. Despite rhetoric about rampant Medicare "fraud and abuse," the fat is now gone from the U.S. medical system, and a brick wall of medical cost inflation is ready to slap us in the face. Amen, brother, amen!