The Senate Finance Committee passed its version of health care reform Tuesday afternoon, but Kaiser Health News reminds us that neither this bill nor any of the others sloshing about Congress will do much about the nation's doctor shortage. Phil Galewitz reports: "Even as Congress moves to expand health insurance coverage to millions of Americans, it's doing little to ensure there will be enough primary care doctors to meet the expected surge in demand for treatment, experts say." 

Primary doctors are key to rural health and there aren't enough of them. The American Academy of Family Physicians predicts a shortage of 40,000 primary care docs in the next ten years. (In the chart above, demand is represented by the blue line; supply of primary care doctors is in red.) “I don't see anything in the legislation that will greatly increase the primary care pipeline," said Dr. Russell Robertson, chairman of the Council on Graduate Medical Education. Galewitz said there's general agreement on how to increase the number of primary care doctors: open more residency positions and increase how much primary care doctors are paid. But nobody wants to add these costs into a health reform bill that has a price tag already too large for many to swallow. To add 15,000 Medicare-funded medical residency positions would cost about a billion dollars a year.

Nor has there been much luck adding to the pay of primary care doctors, since the money would have to be wrenched from specialists. But primary care physicians are key to holding down overall health care costs. They make, on average, less than half of the average for specialists.

Most people get their health insurance through their jobs. But having health insurance appears to be related more to income than to employment.

A renowned family physician explains what the rural outcomes of proposed health care reforms are likely to be. Take a deep breath.

An Associated Press investigation has found widespread contamination in the drinking water at schools. The contamination was "most apparent at schools with wells, which represent 8 to 11 percent of the nation's schools," the AP reported. "Roughly one of every five schools with its own water supply violated the Safe Drinking Water Act in the past decade, according to data from the Environmental Protection Agency analyzed by the AP." We suspect that most schools using well water are in rural communities. 

The AP reports that in "California's farm belt, wells at some schools are so tainted with pesticides that students have taken to stuffing their backpacks with bottled water for fear of getting sick from the drinking fountain." There are 132,500 schools and those with unsafe water represent only a small percentage of those. California had the most violations, followed by Ohio, Maine, Connecticut and Indiana. 

The AP said the problem of tainted school water has "gone largely unmonitored by the federal government." "It's an outrage," said Marc Edwards, an engineer at Virginia Tech University who has been honored for his work on water quality. "If a landlord doesn't tell a tenant about lead paint in an apartment, he can go to jail. But we have no system to make people follow the rules to keep school children safe?"