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Kaiser Health News reported on a shortage of dentists in Tennessee, especially in light of over 600,000 Medicaid patients who might soon receive dental benefits. Part of the shortage of dentists seems to stem from a belief in the 1980s that there would be too many dentists (and so fewer people applied to dental school), but part of the problem also seems to be that dentists might not be paid enough in rural areas, where Medicaid patients might constitute a larger percentage of the overall population. Medicaid often reimburses providers less than half of what commercial insurers are willing to pay. Consequently, many providers may be unwilling to accept Medicaid.

Kaiser Health News reported on a shortage of dentists in Tennessee, especially in light of over 600,000 Medicaid patients who might soon receive dental benefits. Part of the shortage of dentists seems to stem from a belief in the 1980s that there would be too many dentists (and so fewer people applied to dental school), but part of the problem also seems to be that dentists might not be paid enough in rural areas, where Medicaid patients might constitute a larger percentage of the overall population. Medicaid often reimburses providers less than half of what commercial insurers are willing to pay. Consequently, many providers may be unwilling to accept Medicaid.

The article explained that the cost of dental school (probably similar to medical school) is so expensive that most enrollees need to take out large loans, which later require large monthly payments. As a result, recent graduates are more likely to work in urban or suburban areas where they can be paid significantly more. There might be ways to help mitigate this shortage (the article discussed bolstering the finances of two dental schools), but a core issue seems to be that Medicaid does not pay enough. So, even though a Medicaid patient might have insurance coverage, that coverage might not be that helpful if the patient cannot find a provider who accepts that insurance (similar complaints have arisen about Medicare). One way of addressing this would be to require that Medicare and Medicaid have to satisfy the same provider network requirements that are imposed on commercial insurers. Presumably, if insufficient numbers of providers accept those insurance plans, the insurers would need to raise their rates.

We have quietly been working on a number of enhancements to our website. One feature that we have spent a surprising amount of time refining has been the ranking when people sort by reviews. Should a provider with a single five-star review rank higher than a provider that has 20 reviews that average 4.5 stars? We think that for this particular case, the provider with more reviews (and still a relatively high average rating) should rank higher. But the considerations go far beyond simply comparing the volume of reviews. For example, more recent reviews should probably be given more weight than reviews that occurred in the distant past. We reviewed various ranking criteria and settled on one that has recently been released.

We have quietly been working on a number of enhancements to our website. One feature that we have spent a surprising amount of time refining has been the ranking when people sort by reviews. Should a provider with a single five-star review rank higher than a provider that has 20 reviews that average 4.5 stars? We think that for this particular case, the provider with more reviews (and still a relatively high average rating) should rank higher. But the considerations go far beyond simply comparing the volume of reviews. For example, more recent reviews should probably be given more weight than reviews that occurred in the distant past. We reviewed various ranking criteria and settled on one that has recently been released.

It used to be the case that the default sort order did not consider a provider's overall patient ratings, but a couple of providers wrote in suggesting that we change that; we agreed. Naturally, some providers will want to know how to rank higher on our site. For our default sort order, much of what we wrote about earlier still applies, but we have also factored in patient ratings. While we do not want to reveal the ranking criteria in detail, we can say that providers that consistently get five-star ratings will tend to be ranked higher. "Consistently" means that a single five-star review might not have that much effect, but also that one or two unfavorable reviews might also not have too much effect if the overwhelming reviews are positive.

Kaiser Health News reported on assistant physicians, which it explained are medical school graduates who have not yet completed residency training (the article helpfully pointed out that assistant physicians are different from physician assistants). It appears that five states allow assistant physicians to provide medical care. However, apparently, Medicare does not reimburse assistant physicians for their work.

Kaiser Health News reported on assistant physicians, which it explained are medical school graduates who have not yet completed residency training (the article helpfully pointed out that assistant physicians are different from physician assistants). It appears that five states allow assistant physicians to provide medical care. However, apparently, Medicare does not reimburse assistant physicians for their work.

As discussed in the article, there does seem to be a shortage of qualified medical providers. A key question is whether or not assistant physicians are adequately qualified to provide medical care (the article reports that on a national basis, the American Medical Association and the American Academy of Family Physician oppose licensing assistant physicians). It seems likely that there would be some basic level of care that assistant physicians could provide, especially in times of acute shortages of qualified medical personnel. If the availability of Medicare providers were a higher priority (and if Medicare deemed assistant physicians sufficiently qualified to render some services), perhaps Medicare would consider reimbursing assistant physicians some fraction of what they pay physicians.

Also discussed in the article is the American Medical Association's support for increasing the number of residency positions by 14,000 over the next seven years. In a broader economy where suppliers can usually freely enter and exit a marketplace, it is curious that increasing the number of residency positions requires an act of Congress. This policy is likely because the federal government reimburses hospitals to host residency positions and thus, increasing the number of positions requires more budget allocation. Perhaps the industry should propose a more flexible model where the funding is less tied to the federal government. It seems that having more residency positions would alleviate the shortage of physicians while at the same time allowing more medical school graduates to actually train and move on with their careers.

Kaiser Health News reported on a trend that more and more companies that provide health insurance to retirees are relying on Medicare. As background, the cost of health care has been increasing faster than inflation for decades. Companies have turned to a variety of cost-saving strategies, including high-deductible plans and higher co-pays. It appears that now, more companies are shifting their retiree plans to Medicare Advantage, where Medicare pays a private insurer a fixed amount per enrollee per month. When companies sponsor Medicare Advantage plans, Medicare subsidizes the cost of the health care (presumably by the same amount that it would pay for individuals who enroll in Medicare Advantage).

Kaiser Health News reported on a trend that more and more companies that provide health insurance to retirees are relying on Medicare. As background, the cost of health care has been increasing faster than inflation for decades. Companies have turned to a variety of cost-saving strategies, including high-deductible plans and higher co-pays. It appears that now, more companies are shifting their retiree plans to Medicare Advantage, where Medicare pays a private insurer a fixed amount per enrollee per month. When companies sponsor Medicare Advantage plans, Medicare subsidizes the cost of the health care (presumably by the same amount that it would pay for individuals who enroll in Medicare Advantage).

This sounds like a great deal for companies (and it is unclear whether there is any significant disadvantages to doing so), but as long as the amounts are the same as individual subsidies, this seems fair (Medicare likely would have paid the same amount for the same individual enrollee if the retirement health plan did not exist). What seems more questionable is that these company-sponsored Medicare Advantage plans can adhere to weaker requirements (for example, they apparently can have a less robust provider network; some other requirements, such as setting their own enrollment deadlines seem reasonable). It is possible that applying uniform standards would make some retiree plans impractical, but relaxing the requirements could also detract from the patient experience. Regardless, this trend appears to be yet another step towards expanded Medicare coverage.

The current governor of California campaigned on pushing single-payer health care for the state. Kaiser Health News reported on the governor's subsequent distancing from the initiative.

The current governor of California campaigned on pushing single-payer health care for the state. Kaiser Health News reported on the governor's subsequent distancing from the initiative.

Single-payer health care is popular with certain segments of the population, and one can see why a gubernatorial candidate for the state of California would try to campaign for it. However, as the article points out, Vermont had previously approved it but then did not implement it, suggesting that economics can be difficult. The current governor of California seems to have shifted his strategy to something that seems more achievable: "universal health care," which might be implemented via a patchwork of programs, but seems still difficult. Interesting, the governor still supports the idea of single-payer health care, but is deferring to the federal government.