Can Utopia happen in healthcare?

I have seen this New York Times articles referenced in a number of blogs and discussion groups. 

Too Many Doctors in the House

Here is some discussion about the article from the New York Times

This guy, Dr. Goodman, is a professor of pediatrics and family medicine at Dartmouth Medical School.  He believes that the current shortage of physicians is driven by doctors who just want to do more procedure and that doctors really do not have much positive effect on healthcare results.  The only real piece of data that Dr. Goodman cites in the article is the 12,000 geezers that they telephone polled.  Surprisingly, the grumpy old people were not happy with their healthcare, whether there were lots of doctors around or not that many.  Are the elderly ever happy with their healthcare?  They generally want to complain that their doctor only spent 8 minutes seeing them (for the $12 Medicare paid the doctor) to deal with their 8 different medical problems and 15 medications. 

Clearly Dr. Goodman is not involved with recruiting doctors for his hospital.  I am and it is a major struggle.  I know quite  a few people in the recruiting industry and it is a tough business and not getting easier.

Sure, if this country were Utopia and we could get all the doctors to practice the best evidence based medicine, have all of our patients follow instructions, have hospitals cooperate with doctors, and all sing songs around the campfire at the end of the day, his theory might just work.  Unfortunately, this is called "socialized medicine" and it has been tried in many other countries without producing the results he speaks of. 

I do agree that our system is faulty and needs major improvement.  From having practiced in the real world (i.e. not academia,) I have found that the best healthcare available is in areas where managed care has made the least impact and reimbursement is higher.  I practiced in Reno, NV and reimbursement was higher, there were better doctors, lower malpractice rates, and better patient care.  I now work in Las Vegas, where pay is lower, we have a much higher percentage of quacks and charlatans, and patient care is sketchy.  I have seen the same effect in other areas of the country.  Paying everybody more will not change the level of care everywhere, but this is a capitalist country.  If the pay is higher, you get better quality.

There is also the philosophic question of "What do Americans really want from healthcare?"   Are we measuring outcomes that the consumer really cares about?  I have seen that most Americans really see doctors as a way to enable their poor health habits.  Most people in this country don't want to change their diet, exercise, quit smoking, or drink less.  Modern medicine allows them to do that by providing bariatric surgery, Nissen fundoplications, Prilosec, advanced spine surgery, Phentermine, and a host of other American-lifestyle-enabling therapies.  They want these therapies and they want them perfect and they want them now.

So long as Americans continue their current lifestyles, the shortage of doctors will continue.  Perhaps Dr. Goodman's vision could someday be realized, but it would have to happen on a micro-geographic level.  A national system would only turn into another government sponsored FEMA-strophe.