Townhall...
Why
the
Doctor Won’t See You
by John C.
Goodman
Jan 07,
2012
Are you
having difficulty finding a doctor who will see you? If you are, brace
yourself. Things are about to get a whole lot worse.
Right now,
the biggest problems are in Massachusetts. If you live in Boston and
are trying
to see a new family doctor, get prepared to wait more than two months
before
you ever get a foot in the door. For the state as a whole, the average
wait to
see a new family doctor is one month. More than half of all family
doctors and
more than half of all internists are not accepting new patients at all.
What if you
live in another state? Just wait two more years. In Massachusetts
people are
lined up waiting to see doctors because of the health reform championed
by the
former governor (RomneyCare). And as Barack Obama has said on more than
one
occasion, RomneyCare is the model for ObamaCare.
Why? In
both the Massachusetts health plan and the new health care law the
mistake is
the same: insuring the uninsured, but doing nothing to enable the
medical
community to deliver more care. Massachusetts succeeded in cutting the
number
of uninsured in half — a worthy accomplishment. But the state did
nothing to
expand the number of doctors, nurses or paramedical personnel. The
result: a
major increase in the demand for care, but no change in supply.
I learned
what this means in human terms a while back from a Boston cab driver.
She was
on MassHealth (Medicaid) and her biggest problem, she told me, was
getting
care. “I went down a list of 20 doctors before I found one who would
see me,”
she said. “Twenty doctors?” I responded incredulously. “Were you going
through
the Yellow Pages?” “No,” she said, “I was going down the list
MassHealth gave
me.”
In Massachusetts,
this is what the advocates of health reform call “universal coverage.”
Bad as all
this is, it is actually rather mild compared to what is about to happen
in
other states. In Massachusetts, less than 10 percent of the population
was
uninsured before the reform set in. In Texas, by contrast, one in every
four
people is currently uninsured. Insure half of those and the demand for
Texas
doctors is going to soar.
Estimates
are that ObamaCare will succeed in insuring 32 million otherwise
uninsured people.
If economic studies are correct, once these folks are insured, they
will try to
double their consumption of health care. On top of that, ObamaCare does
something that Massachusetts did not do. It will force the vast
majority of
people who already have insurance to switch to more generous coverage.
For
example, everyone will have to be covered for a long list of preventive
care
and diagnostic screenings, with no copay and no deductible. Once people
have
this extra coverage, they will be inclined to take advantage of it.
Get
prepared, then, for a huge increase in the demand for care. The result
will be
growing waiting lines — at the doctors’ offices, at hospital emergency
rooms,
at the health clinics, etc.
In the
early stages of Massachusetts’ health reform, Governor Romney told me
what he
expected to happen. Instead of uninsured patients going to hospital
emergency
rooms to get expensive care in inappropriate settings (all paid for by
the rest
of us), he said, insured patients will be getting less expensive care
in the
offices of primary care doctors.
Ah, but the
best laid plans …. Turns out that more people are currently seeking
care in
hospital emergency rooms and at publicly funded community health
centers than
there were before the reform! As one academic study concluded, in
Massachusetts
you have the same people seeking the same care at the same places you
had
before. Health reform has mainly meant shuffling money around from one
bureaucracy to another.
When health
care is rationed by waiting, who gets care and who doesn’t? Here is the
real
surprise. Just as ObamaCare intends to do, Massachusetts set up health
insurance exchanges where the uninsured could obtain insurance, in most
cases
with generous government subsidies. Yet the newly insured are the
patients
having the greatest difficulty obtaining access to care. According to
one
report:
• Only 56
percent of family doctors accept patients enrolled in Commonwealth Care
(subsidized insurance sold in the “exchange”).
• Only 44
percent accept patients in Commonwealth Choice (unsubsidized insurance
sold in
the “exchange”).
• The
fraction of internists who accept Commonwealth Care and Commonwealth
Choice is
43 percent and 35 percent, respectively.
In
Massachusetts this is called “access to care.”
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