Hank Kalet

A quick glance at today’s story in The New York Times on the expanding shortage of physicians might leave the impression that the Affordable Care Act is to blame. Starting with an accurate, if somewhat misleading, headline — “Doctor Shortage Likely to Worsen With Health Law” — it then goes on to explain the dynamics of the growing shortage.

The Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed. And that number will more than double by 2025, as the expansion of insurance coverage and the aging of baby boomers drive up demand for care. Even without the health care law, the shortfall of doctors in 2025 would still exceed 100,000.

Health experts, including many who support the law, say there is little that the government or the medical profession will be able to do to close the gap by 2014, when the law begins extending coverage to about 30 million Americans. It typically takes a decade to train a doctor.

A close read — and a quick glance at the paper’s chart — makes it clear that we are looking at a one-time bump in need and that the issue at hand is not the health law but the health system itself. There is a dangerous shortage of doctors now, especially primary care physicians, and any stress put on this shortage is due only to the need to cover more uninsured Americans.

So, what are the issues? First, there is the confluence of population growth and the aging of the population.

Across the country, a factor increasing demand, along with expansion of coverage in the law and simple population growth, is the aging of the baby boom generation. Medicare officials predict that enrollment will surge to 73.2 million in 2025, up 44 percent from 50.7 million this year.

“Older Americans require significantly more health care,” said Dr. Darrell G. Kirch, the president of the Association of American Medical Colleges. “Older individuals are more likely to have multiple chronic conditions, requiring more intensive, coordinated care.”

The pool of doctors has not kept pace, and will not, health experts said. Medical school enrollment is increasing, but not as fast as the population. The number of training positions for medical school graduates is lagging. Younger doctors are on average working fewer hours than their predecessors. And about a third of the country’s doctors are 55 or older, and nearing retirement.

Just as significantly, the Times reports, compensation remains a problem, encouraging med students to pursue the glamour specialties (I.e., plastic surgery) at the expense of primary care and general medicine.

The proportion of medical students choosing to enter primary care has declined in the past 15 years, as average earnings for primary care doctors and specialists, like orthopedic surgeons and radiologists, have diverged. A study by the Medical Group Management Association found that in 2010, primary care doctors made about $200,000 a year. Specialists often made twice as much.

The health-care system in the United States is broken. Its incentives have nothing to do with care and remain based on profit and money. The cost of becoming a doctor is enormous; recouping that money means chasing the big payday offered by the specialties, a recipe for poor care.

Tinkering around the edges, as the ACA does, is not a solution, but it aloso is not the problem.

We need systemic change in the form of single-payer.

I wrote about this last week, but today’s report on food prices adds emphasis.

The worst drought in the United States in nearly a half-century is expected to drive up the price of milk, beef and pork next year, the government said Wednesday, as consumers bear some of the brunt of the sweltering heat that is driving up the cost of feed corn.

Poultry prices are expected to rise more immediately, the government said in a report. It estimated that consumer price indexes for chicken and turkey would rise 3.5 percent to 4.5 percent later this year.

“The poultry category is the smallest animal category, and we expect to see more of an effect this year because they grow the fastest and will be first to be impacted by higher feed prices,” said Richard Volpe, an economist with the Department of Agriculture.

Figures released Wednesday by the department showed the largest percentage increase next year in its price indexes is expected for beef, a rise of 4 percent to 5 percent. The price of dairy products will increase 3.5 percent to 4.5 percent and eggs by 3 percent to 4 percent. Pork is expected to rise 2.5 percent to 3.5 percent.

We are facing a climate crisis that is having tangible effects on our lives, including our wallets. We no longer can pretend the problem doesn’t exist.

The pay rate, explained Maia Davis, a spokeswoman for 32BJ, the local chapter of the Service Employees International Union, is either based on the wage set for a job sector via collective bargaining or, if there is no large collective bargaining agreement, at 150 percent of the federal minimum wage.

In city owned buildings, janitors’ pay would jump from $10.50 an hour to $14.15 an hour, as per the standard pay already set in Hudson County through collective bargaining in the private sector, and they would be provided with $649 per month in family coverage for benefits. This standard would also be set for janitors in city-subsidized buildings who weren’t previously covered by the living wage ordinance and who were making significantly less.

Similarly, security officers in city-owned buildings would see their pay go up to 150 percent of the federal minimum wage, currently set at $10.88 per hour, because there is no standard set in the county. Davis, however, said the union is working on achieving this. The officers’ benefits would be unchanged, and is worth $3.10 per hour. By comparison, those who work in city-subsidized buildings were often only making minimum wage. They too will now be covered in future projects economically subsidized by the city.

Clerical and food service workers would also see a wage increase of 150 percent of the federal minimum wage, and their benefits would bump up to the $3.10 per hour supplement the security officers already receive. Prior to the bill’s passing they received $2,000 in health benefits for the year. These employees would not be covered in city subsidized buildings, however.

Jersey City is the first in the state to pass a living wage ordinance, so it will be a test case here. Research on other living wage ordinances is mixed, though most show a reduction in poverty and an increase in wages for the lowest-wage earners in cities where the wage has been imposed.

The hope is that Jersey City will ignite a small brush fire that will lead to more living wage ordinances in the state.

Gas prices have been in a moderate flux so far this summer, but they remain below last year’s level.

Thanks to the brutal drought covering more than half the nation, we are not going to be able to say the same about food prices.

An analysis released on Thursday by the United States Drought Monitor showed that 88 percent of corn and 87 percent of soybean crops in the country were in drought-stricken regions, a 10 percent jump from a week before. Corn and soybean prices reached record highs on Thursday, with corn closing just over $8.07 a bushel and soybeans trading as high as $17.49.

This is likely to mean not just higher prices for produce, but for meat and milk, as well, even as their quality decreases.

The withering corn has increased feed prices and depleted available feeding land, putting stress on cattle farmers. A record 54 percent of pasture and rangeland — where cattle feed or where hay is harvested for feeding — was in poor or very poor condition, according to the Department of Agriculture. Many farmers have been forced to sell their animals.

Because feed can account for nearly half of a cattle farmer’s costs, consumers could see a rise in the price of meat and dairy products, experts said. The high sustained heat has led the key components in milk, like fat and protein, to plummet more than usual, said Chris Galen, a spokesman for National Milk Producers Federation.

The drought appears to be caused by natural weather patterns, though man made climate change has sped its spread and deepened its impacts. The natural defenses that have mitigated past droughts have been eroded, leaving us far more susceptible to weather shifts than in the past.

Richard Seager, a professor at the Lamont-Doherty Earth Observatory at Columbia University, and a prominent drought researcher, told Climate Central that the drought’s “origins can be traced to the tropical Pacific Ocean, where a periodic cooling of sea surface temperatures — a phenomenon known as La Niña — helped reconfigure global weather patterns during the past two years.” Global warming, however, has played a major role, as well.

Unlike the droughts of the 1930s, this one is occurring in a much warmer climate, a byproduct of manmade global warming. Seager said that although it most likely didn’t trigger the drought, it’s possible that global warming is making this drought worse than it would otherwise be.

“I think what we’re seeing is largely a naturally occurring event, but it’s occurring against the background of a warming environment,” Seager said.

Mark Svoboda, at the National Drought Mitigation Center in Lincoln, Neb., said soil has been dry and, because of that, there is little evaporation. This can help accelerate warming and droughts. Essentially, he says, it is the drought “feeding on itself.”

Kevin Trenberth, at the National Center for Atmospheric Research in Boulder, Colo., points the finger at climate change, saying “global warming helps make droughts hotter, and therefore drier, than they would be without a human influence.”

Manmade global warming, he said via email, “. . . means more energy that has to go somewhere. In dry conditions it amplifies drying and goes into heating, creating heat waves. It is small on a day-to-day basis, but is always in one direction and it creates stronger, more intense, and longer-lasting drought. No doubt about it.”

Our failure to address climate change — and even to acknowledge it as one of the greatest threats we face — is not just an environmental problem. As the impact on he food supply and prices makes clear, it is an economic one, as well.

Unemployment in New Jersey is not getting any better.

According to a report today on NJ.com, the state’s unemployment rate jumped a half point in May, from 9.2 percent to 9.7 percent, making it clear that the state is not — contrary to what Gov. Chris Christie has claimed — in the middle of a miracle recovery.

The state’s unemployment rate stood at 9.6 percent in October, just weeks before the election that brought Christie into the Statehouse. It peaked at 9.7 percent during the first couple of months of his term and then dipped to the low 9s where it remained until today’s report.

And it has remained well above the national figure for quite some time.

Christie avoided commenting today — the numbers had not been released when he spoke at a news conference — but his M.O. generally has been to blame the “Corzine Democrats” for the state’s economic woes, for everything bad, in fact, while taking credit for whatever good news comes along.

At some point, however, Christie has to take responsibility for the stalled state economy — just as President Barack Obama must take responsibility for the stagnant national one. Christie is nearing the end of his third year in office and, by virtue of the state constitution, commands a level of executive authority that almost no other governor commands and that the president can only wish for.

Instead, he has colluded with his Democratic opponents in approving a budget with unrealistic revenue expectations that are based on the false promise of a major recovery in process.

That’s not straight-shooting. That’s just B.S.

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