Health care reform

The Doctor Will Not See You Now

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Even if implementation of ObamaCare goes more or less as planned and ends up expanding health coverage to about 30 million over the next decade, as the latest Congressional Budget Office report on the law projects, it is still quite likely that significant health access issues will remain.

As The Washington Post's Sarah Kliff reports today, a recent study by a researcher at the Center for Disease Controls recently looked at 2011 survey of doctors and found that nearly a third said they did not accept new Medicaid patients last year:

[The study] used a survey of 4,326 office-based physicians from across the country to find that 69.4 percent said they were accepting new Medicaid patients. That number was significantly lower than those accepting privately-insured subscribers (81 percent) or Medicare patients (83 percent), indicating that this wasn't just about doctors being overbooked – it was specific to the Medicaid program. The lower acceptance of Medicaid programs also held when Decker broke down doctors by specialists and primary care providers.

Given that much of ObamaCare's coverage expansion relies on Medicaid, this is not an encouraging sign for the millions of individuals who are supposed to be shuffled into the program as a result of the law. 

Indeed, as The New York Times reported recently, the law's coverage expansion is likely to exacerbate a growing doctor shortage that was already in the works before the law passed:

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.

"We have a shortage of every kind of doctor, except for plastic surgeons and dermatologists," said Dr. G. Richard Olds, the dean of the new medical school at the University of California, Riverside, founded in part to address the region's doctor shortage. "We'll have a 5,000-physician shortage in 10 years, no matter what anybody does."

Our best real-world test case for the law—RomneyCare, the Massachusetts health care overhaul that served as the model for ObamaCare—makes clear that the problem is real. Despite the highest health coverage levels of any state in the country (somewhere between 94 and 98 percent), some 14 percent of sick adults still reported being unable to access a doctor in the state last year, according to a study by the Harvard School of Public Health. And the problem seems to be getting worse: 63 percent of participants in the Harvard study said they thought their access troubles had become worse in the five years since RomneyCare became law. 

None of these discoveries are recent: We've seen longer lines and hospital wait times in Massachusetts for years, Medicaid (and to a lesser extend Medicare) beneficiaries have had trouble finding willing providers for a long time, and it was clear that a doctor shortage was coming before ObamaCare was passed into law. But ObamaCare's backers in Congress and the White House decided that, despite these problems, it would be a good idea to commit somewhere in the neighborhood of $2 trillion over the next decade to expanding health coverage. So not only did the law fail to solve many of the U.S. health system's existing problems, it also added a fiscal strain that could well make those problems harder to fix. 

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  1. Fuck that. Let’s get this piece of shit repealed during the next Congress.

    1. what’s worrisome, however, is how the Repub mantra has become “repeal and replace.” Well, replace with what? A less intrusive govt program?

      1. My hope is that this sort of shit becomes unpopular to the point that the GOP is skullfucked and hounded into repeal and deregulation, not replacement with some other governmental bullshit.

        1. This clusterfuck will never be repealed. It will die a slow and agonizing death and drag a whole lot of the middle class down the toilet with it.

          1. There’s still a very, very real chance it can be killed before it fucks us up completely. I’m going to hope and pray for that chance all the way through the next Congress.

            1. Even if the GOP have the Senate, it won’t matter, Obama will veto it. I don’t believe that the GOP will have the Senate anyway, but if they do…

              Roberts really fucked us, the statists won big time on this one. It may not take anything more at all to kill any liberties that we have left. I haven’t read the bill, but I have heard that there are all kinds of things in there that will be interpreted in ways that will be very harmful to our republic.

              1. I think the Repubs will kill it even if it is by piecemeal dismemberment. Even if they don’t, the oncoming fiscal paradigm shift will end Ocare. It’ the Robers precedent that’s really worrisome. The only hope is to get some fantastic freedom lovers on the scrotus.

                1. They should be renamed, the SCREWUS. In fact, that would be the best name to include all 3 branches of the gubmint.

  2. Well, clearly the next step will be to force doctors at bayonet point to see new patients.

    Duh! What’s so hard about that?

    1. You joke, but I guarantee you something will be proposed that essentially forces doctors to service Medicaid patients whether they want to or not.

      1. Sure. Someone will pass an addition to the ADA that defines poverty as a qualifying disability.

      2. If healthcare is a right, then someone, somewhere, has to provide it whether they want to or not.

        1. Don’t think that plenty of doctors haven’t come to that same conclusion, Hugh.

          They think there are shortages now? Just wait.

          1. In the brave new state, government will just start deciding what career we will be guided into by some form of testing, or just whatever whim they have at the moment. There will not be any choice, choice is bad for the collective.

            1. Oh, you’ll get a choice. Doctor or field hand.

      3. This is easy, tie it to state licensure. They already do something similar this if you want to open an outpatient surgery center in Georgia. You cannot get a certificate of need (basically a permit to open one) if you don’t promise to see a certain percentage of Medicaid/year.

        1. Yup. Probably won’t be able to renew state licenses without agreeing to see a certain number or percentage of medicaid pts.

          And then they can lower the reimbursement rates even more!

          But god forbid they would ever do malpractice reform, because lawyers should not have any constraints on their incomes.

    2. That is completely humane. For the collective you know, for the collective.

  3. From Truman’s speech at the signing of the Medicare/Medicaid act into law:

    This is an important hour for the Nation, for those of our citizens who have completed their tour of duty and have moved to the sidelines. These are the days that we are trying to celebrate for them. These people are our prideful responsibility and they are entitled, among other benefits, to the best medical protection available.

    Not one of these, our citizens, should ever be abandoned to the indignity of charity. Charity is indignity when you have to have it. But we don’t want these people to have anything to do with charity and we don’t want them to have any idea of hopeless despair.

    I’ve got a friend whose mom who has been hospitalized and in a rapid decline. Guess how the staff at the hospital have been treating her? Like shit, because any help they give her won’t increase their payout and might mean additional paperwork, while if they ignore her pleas for water or assistance with going to the bathroom they face no consequences.

    I am literally angry with rage at how the act essentially forces every body at the end of their life to go through the indignity of DMV style medical care.

    1. Not one of these, our citizens, should ever be abandoned to the indignity of charity.

      Well, at least he was honest.

      1. Charity bruises your dignity only when it comes from other people. When you get it from the government, there is nothing to be ashamed of. I mean, what was the government going to do with all that extra money they have laying around anyway? Spend it on some stupid Mars rover? Partying with your SNAP is cool and trendy, and a basic human right!

    2. That’s another hour of enraged pacing. Mother of God, how I detest statist fucks.

    3. the indignity of charity

      Nice band name Obama book title.

  4. Here’s the thing with entitlements:

    People who don’t have Medicaid won’t go to the ER for their primary care, even though they won’t wind up paying for it anyway. But, as soon as they get Medicaid, they start hitting the ER.

    Put somebody on a program, and they start feeling entitled and acting entitled. Expanding Medicaid is a disaster for hospitals, because our costs go up and Medicaid only pays a fraction of those costs.

    1. Government entitlements are grand. I really love seeing couples with 3 or 4 children paying for their 5 full carts of groceries with government food programs, and then leaving the store and getting into a brand new Cadillac Escalade, which the entire family combined will outweigh by at least a ton.

      1. it’s not just the heaping grocery carts, it’s the items in them..things you, being a peasant on a budget, cannot necessarily afford. A lot of those kids are on free lunch at school, too, but always seem to have money for vending machines.

      2. A friend and I were behind a lady with a cart full of cake mix. My friend querried her about it and she said she had a cake business. It was a real pisser when she paid paid for it with an EBT card. Of course in Memphis, using your own money carries a stigma.

        1. That cake business … She didn’t pay for that.

        2. Wow, just wow.

      3. I don’t know why people are surprised that when we give money (or its nearly fungible within the grocery store equivalent) to people make bad decisions with money and then they go out and make bad decisions with it. I have totally made peace with it.

  5. ACA was never about controlling costs or making health care available to more people, and everyone knew it. It was about control, and it was about buying votes with entitlements. The only negative, unintended consequence of passage any legislator considered was the possibility of losing support or losing his seat.

  6. And that number will more than double by 2025,

    You can thank the Guild for the shortage.

    “We have a shortage of every kind of doctor, except for plastic surgeons and dermatologists,”

    No shortages when much of the business isn’t covered by insurance, much less welfare programs.

    1. No shortages when much of the business isn’t covered by insurance, much less welfare programs.

      Purely coincidental, I’m sure.

    2. Similarly, no shortage of veterinarians.

      “The vet, uh, *Doctor* will see you now.”

      1. Just wait till we get National Pet Care.
        I’m hoping this planet turns into smoking, glowing rubble inhabited by cannibalistic mutants before it’s signed into law

        1. Just wait till we get National *Plant* Care.

      2. Honestly, I was talking to my boss’s wife the other night who is a vet getting advanced training in laproscopic surgery. She thought I was joking when I asked her if I could call her if I needed my gallbladder out. But I’d be totally down as long as my gallbladder is in approximately the same place and would look the same as a dog’s.

        1. It is. Dogs livers are funky but GBs are about the same.

  7. The Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed.

    Why, those inhuman, greedy doctors! Who do they think they are, profiting from the pain of their fellow man?

    It’s just like those inhuman, greedy mechanics, profiting from people’s need for running A/C!

    It’s just like those inhuman, greedy farmers, profiting from people’s needs for food!

    It’s just like those inhuman, greedy umbrella manufacturers, profiting from people’s need to stay dry!

    It’s just like those inhuman, greedy….

    “What is what Tony is thinking, Alex?”
    “Correct, for $1,000.00!”

  8. So not only did the law fail to solve many of the U.S. health system’s existing problems, it also added a fiscal strain that could well make those problems harder to fix.

    Especially considering just how fucked-up regulated is the industry.

    My own solo cardiologist was forced to close his practice last Fall and seek employment with an area hospital, due to declining reimbursement levels. More than 51% of cardiologists in the U.S. are now hospital employees. One of my medical school classmates, a successful internal medicine specialist, has recently given up the fight and has plans to enter some other line of work. Several friends in Radiology have seen their incomes decline as more and more work is “outsourced” to tele-docs in Asia. Still other long-time friends who are general surgeons are struggling to survive (a surgical fee for incisional cholecystectomy, for instance, is now under $400). Several have retired prematurely and others are looking for other work to do. As a final example, another of my friends is one of five physicians in a busy urology practice (2 offices and 26 employees) and they are now borrowing from the bank to make payroll. A recent article from CNN, “Doctors Going Broke,” confirms the growing problem.

    1. So not only did the law fail to solve many of the U.S. health system’s existing problems, it also added a fiscal strain that could well make those problems harder to fix.

      you would like to say this was the exception, that the medical system is remarkably different from everything else on which govt has intruded, but it’s not; this is the norm. Whatever “problem” is tackled by govt action usually winds up becoming even worse and new (probably foreseeable) problems also crop up.

  9. But the British were singing and dancing about the NHS at the Olympics. Socialized medicine can’t be all bad.

  10. I love coming here for the umpteenth iteration of the argument that “the lifeboat is getting too crowded so we have to throw one third of the people overboard.”

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