Issues in Implementation of Health Care Reform Legislation: Part One – Student Indebtedness

Resized image from www.pbs.org
Resized image from www.pbs.org

Over the past 21 years, the National Conferences on Primary Health Care Access have identified many factors that have resulted in observable imbalances between primary and subspecialty medical care and imbalances between public health needs and the resources applied to them.

The most recent National Conference (April 2010) examined some of the consequences of the recent legislation passed by Congress and signed by President Barack Obama.

The legislation enacted is the most comprehensive in more than a generation, and provisions of it should bring about important improvements in primary health care access. Even so, a significant percentage of the American population is skeptical that the legislation will be effective, and a large number doubt that what the legislation contained is what should have been enacted. Like Medicare and Medicaid, both enacted 45 years ago, it is quite likely that many of its consequences will be unintended and unexpected.

Over the next several months, in preparation for the 22nd National Conference on Primary Health Care Access in San Francisco (April 18-20, 2011), we will study some of the provisions that seem particularly hopeful for improving primary health care access. Likewise, we plan to propose several issues for discussion that perhaps were inadequately discussed during the recent legislative process.

The first of these inadequately addressed issues is the matter of student indebtedness (particularly the amount of loans that have been amassed by students pursuing medical degrees) and its potential impact on physician supply and the processes by which medical school graduates select their specialties.

As an introduction to the subject, we will examine a case study of the combined student debt of a married professional couple – one a physician and one a lawyer. (See Drowning in Student Debt: Young Professionals at the End of Graduate School.)