Obamacare

Report: Obamacare Patients Likely To Struggle To Find Doctors

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Medicine man

The big selling point of the Affordable Care Act — "Obamacare" to you and I — has been the extension of health-plan coverage to uninsured Americans. The implicit promise was that extending coverage would extend actual care. But yet another study suggests that these new medical customers, many of whom would be accommodated by expanding Medicaid, may not be able to find physicians willing to take them on.

Published October 12 in the American Journal of Medical Quality, the study with the patience-trying title, "Characteristics of Primary Care Safety-Net Providers and Their Quality Improvement Attitudes and Activities: Results of a National Survey of Physician Professionalism" surveyed "safety-net" physicians, so-called because they handle the bulk of uninsured and Medicaid patients, What the authors found is that these health-care providers are already reaching their limits even before expansion takes place.

The full text of the report is behind a paid firewall, but a handy press release about the study from Massachusetts General Hospital hits the high points:

The authors note that the concentration of care for Medicaid and uninsured patients among a limited number of safety-net physicians and the fact that 28 and 39 percent, respectively, of those physicians are not accepting new Medicaid and uninsured patients indicate that the current health care safety net may have reached its capacity. In addition, they note, safety-net physicians' interest in quality improvement and attention to health care disparities suggests that reported differences in the quality of care they provide probably reflect limited resources available to their practices or barriers to care within the local communities.

The authors of the study draw logical inferences for the expansion of demand for safety-net physicians — and even for insured patients who may already be running into difficulties finding doctors as some physicians become demoralized and even cut back or leave the field.

"This study raises very serious concerns about the willingness and ability of primary care providers to cope with the increased demand for services that will result from the ACA," says Eric G. Campbell, PhD, of the Mongan Institute, senior author of the report to be published in the American Journal of Medical Quality. "Even with insurance, it appears that many patients may find it challenging to find a physician to provide them with primary care services."

It's possible that alternative providers, such as nurse practitioners could help fill in the gap, especially on day-to-day care. But state-level licensing laws have stood in the way of exactly that for decades. Reports Stateline.org:

A 2010 Institute of Medicine report, "The Future of Nursing," cited nearly 50 years of academic studies and patient surveys in concluding that primary care provided by nurse practitioners has been as safe and effective as care provided by doctors. But efforts to change "scope of practice" laws to give nurse practitioners more independence have run into stiff opposition.

Organized physician groups, which hold sway in most legislatures, are reluctant to cede professional turf to nurses. Arguing that nurse practitioners lack the necessary level of medical training, they insist that it is unsafe for patients to be treated by nurse practitioners without a doctor's supervision.

So, if you have a medical provider you like, I recommend that you cling tight and hang on for the ride. The next few years should be interesting.

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64 responses to “Report: Obamacare Patients Likely To Struggle To Find Doctors

  1. …may not be able to find physicians willing to take them on.

    Obviously Congress would not have passed a piece of legislation as comprehensive the Affordable Care Act without having taken into account this probable consequence of the bill and made provisions to correct it. Someone just has to get in there and really look at the law and find where it accounts for and corrects this situation.

    1. If you were able to type this with a straight face, my hat is off to you sir.

      1. Actually, he types it looking like this.

        1. Sorry, I was wrong. He looks like this.

          1. Fist is a Juggalo funeral?

            I KNEW IT!

            1. I have existed as many events throughout time and space, some the heights of ecstasy, some the depths of despair, but never anything involving soccer.

              1. soccer is null

          2. MY god, that is sad.

              1. Amazing, isn’t it?

            1. Who knew you could actually bury your dignity.

              1. Well, you did, Hugh. From experience. Don’t you remember that night, or did you drink the memories away?

            2. Yeah, I actually clicked through now and it may be sadder than the John Travolta/ONJ music video I watched in the PM links.

    2. “…and made provisions to correct it.”

      They may not have put it in the text of obamacare, but I assure you they already have plans to fix it. All Docs will simply be forbidden by law to refuse medicaid patients. Well, all except the select few Docs that treat the privileged and will be given exemptions.

      As for the precipitous decline in physicians that will be the inevitable result of that brilliant fix, I am sure they have a fix in mind for that as well. Care to guess what it is?

      1. Federally run medical Neducation centers?

      2. What is going to happen is already happening. You are basically going to be seeing the end of “private practice” docs except for those who run “boutique,” cash-only practices (until they make that illegal). Anyone with insurance, Medicaid, or Medicare will be shunted to big clinics with docs on salary, where all the operating costs are consolidated. If any of you have Kaiser and know what that is like — everything under one roof — that is what you will see in the future.

    3. I’m sure they’ll come up with a nuanced solution. For instance, they can push the “use force” button. Works on everything at all times!

      1. See Jordan’s comment below. I am sure that is just crazy talk.

  2. And you know who will be to blame, of course. Libertarians, the evil Illuminati gnomes foiling the plots of top men with their dogma.

  3. they insist that it is unsafe for patients to be treated by nurse practitioners without a doctor’s supervision.

    If the “pre-med” students I knew in college are indicative of the quality of doctors in America today, this is not funny, it’s pathetic.

  4. Organized physician groups, which hold sway in most legislatures, are reluctant to cede professional turf to nurses. Arguing that nurse practitioners lack the necessary level of medical training, they insist that it is unsafe for patients to be treated by nurse practitioners without a doctor’s supervision.

    More “unsafe” than not to be treated at allFuck the guild. End professional licensure. Doctors are the worst sort of rent-seeking scum.

    1. My dad was the executive director the the National Society for Medical Research for a long time, and was so successful in the job that he was poached away by the AMA. When he suggested they should advocate for increased medical school slots and decreased barriers to entry in to medicine, they fired him.

      1. “When he suggested they should advocate for increased medical school slots and decreased barriers to entry in to medicine, they fired him.”

        I’m laughing. but I shouldn’t be.

        1. Why the hell doesn’t the wider health care discussion include terms like “empowering nurses” and “decreasing barriers to entry into medicine”? What would it take to get that perspective into the debate, with other terms like “making health care more affordable” and “innovation” and “personal choice,” instead of quibbling about how much the government spends and controls?

          Why not castrate the FDA by arguing for the “right to experimental medicine”? (By which I mean: drug companies should be allowed to sell things on an “experimental, use at you own risk” basis without FDA approval.)

          Ideas like this have appeal for many voters, and seem like a good way of pushing libertarian solutions to health care that the left can’t easily demonize as “cruel” or “greedy.” Let them oppose “empowering nurses”! Let them argue that it’s really, really important that we not have more people in medical school, that they must remain exclusive and expensive and difficult.

  5. Well, yeah, but at the same time, if you don’t have a doctor now because you can’t afford one, how is Obamacare any worse?

    I’m sorry, but somehow Costa Rica manages to provide health care to all its people. Obamacare clearly isn’t the answer, but neither was the status quo (which was not even remotely free market). We should be looking at how other countries do it, and as I mentioned, Costa Rica seems to have a pretty decent model, despite essentially being a 3rd world country.

    1. Is costa rica’s solution:
      1) treat patients with 1970s era technology;
      2) pay doctors and other staff a small fraction of what they are paid in the US?
      If so (as I suspect), that’s not really a solution that’s going anywhere.

    2. Well, yeah, but at the same time, if you don’t have a doctor now because you can’t afford one, how is Obamacare any worse?

      If you can’t find a doctor because they won’t take Medicaid, that doesn’t exactly improve the situation.

      We should be looking at how other countries do it, and as I mentioned, Costa Rica seems to have a pretty decent model, despite essentially being a 3rd world country.

      Or, we could just go back to a cash-based system like we had 60 years ago, restrict “insurance” to catastrophic and emergency events only rather than as the first line of payment, and mandate price listing of services in hospitals.

    3. I don’t know if I’d describe Costa Rica as a third world country. It might not be first world, but it’s not Zimbabwe either. And just because someone has a government health insurance card doesn’t mean they’re actually going to get care or that the care they receive is of high quality

    4. Well, yeah, but at the same time, if you don’t have a doctor now because you can’t afford one, how is Obamacare any worse?

      Because I have to ay for all of that non-care happening.

    5. Well, yeah, but at the same time, if you don’t have a doctor now because you can’t afford one, how is Obamacare any worse?

      How many people to be jailed is too many, for you to not get your Free Shit? How many people have to be killed or maimed? Is there a limit?

      When, exactly, does the machine of security become too brutal for even a socialistic chucklehead like you?

  6. But state-level licensing laws have stood in the way of exactly that for decades. Reports Stateline.org

    I predict that instead of doing the obvious, smart thing – repealing licensing laws – progressives will turn the fascism dial up to 11 and start drafting people into med school and , preventing doctors from retiring, etc.

    1. See my post above. You win the prize.

      1. Wayback machine: Belgium threatens to draft doctors into their Army if they don’t accept socialized medicine.

        1. “…some doctors reported receiving anonymous threats.”

          How long before people here picket/threaten/attack docs?

          I see the future of the medical profession as a underground black market for real docs and a potemkin village as the government approved one.

          1. I’ve been saying, this is what the seasteaders should be doing — resort hospitals, just out in international waters, under a flag of their choosing.

  7. I have two very good girlfriends from my childhood who have graduate degrees in public health (one has her MS from Tufts and is working for Group Health in Seattle and the other has a PhD from Johns Hopkins and is doing some kind of post-doc work at U of Michigan). They don’t know each other, but they are both VERY LIBERAL politically, and they both have assured me in numerous FB threads that Obamacare would increase health care access for everyone. They offered no proof, nor any theory as to the mechanism that would cause it. Just (religious) faith in Obama and the Democrats to provide health care to the masses.

    Considering that in both cases I became friends with these girls because we were in TAG/GT classes together, which require 130+ IQ for admission, this pretty much sums up why we’re doomed as a country, when two of the smartest girls I’ve ever known can’t/won’t think about consequences of their political beliefs.

    1. Thanks for the downer, Christina, I usually assume these people are at least low-IQ.

      1. I’ve puzzled over this disconnect between high-IQ and the refusal to think deeply about public policy consequences for a while now. After all, I was born in Washington DC, grew up in NoVa, and have lived here my whole life. I am surrounded by very smart, well-educated people, and yet very few are libertarians (or even lean in that direction).

        Since I have always been a libertarian, I have no idea how statists think, and when I ask them in forums like FB, they don’t respond. The closest I can come to an explanation is that they are religious fanatics who prize faith over reason.

        1. That’s essentially it. A person can be “smart”, but that does not make them rational or logical. Very intelligent people can believe really, really stupid things. And some of those beliefs, especially partisan TEAM beliefs, can and do reach a religious-type level.

          Don’t expect smart people to not be stupid, and to be stupid a lot, unless they are also rational and logical.

          1. Also, rationality can be compartmentalized.

          2. A person can be “smart”, but that does not make them rational or logical.

            See that’s where you lose me.

            No, not really, that’s when you make me face reality and cry.

          3. You assume that all rationality is the same. If we operate under the understanding that the outcomes of policy decisions that produce the most good are the best then, we would advocate policies varying wildly from someone who sees liberty as a positive outcome in itself.

            I make no claims that what I believe is any more rational than what the other guy believes, but I will claim that I don’t believe in policy that is only enforceable through violence and murder.

          4. I predict that scientists, 1,000 years from now, are going to look back at this period and wonder how mankind survived this period, when 99% of the population was afflicted with the very serious mental illness known as “partisan ideology.”

        2. I’ve puzzled over this disconnect between high-IQ and the refusal to think deeply about public policy consequences for a while now.

          No matter the intelligence, no one brain could ever make decisions for 300 million individuals better than individuals could for themselves.

          Some, because they fit shapes together well, do word association chores with proficiency, and tell professors what they want to hear are arrogant enough to think that their opinions about another’s doings are more valid than said individual’s, not realizing that intellectual arrogance is the worst kind of stupidity there is.

          My IQ is in the 60-70 range but I am at least smart enough to realize these things. COokie!

          1. I’ve puzzled over this disconnect between high-IQ and the refusal to think deeply about public policy consequences for a while now.

            They’re very smart and they believe this to be true, therefore, it must be true.

            It’s the circle jerk of life.

        3. One can be very smart and draw extremely logical, rational conclusions with the data they have. The problem is people, of all intelligence levels, are economically ignorant, particularly of one fact – scarcity. They are programmed that way. It’s like trying to apply ones brain to questions of physics without being aware of gravity. You’ll get some pretty logical and correct deductions that would exist in a gravity-less world.

          Also, some very bright people, over hundreds of years, have made some very long, involved dissertations with air-tight logical connections that sound splendid, but they’re based on a premise of a Fairie.

          At it’s core, IQ is an ability to see patterns and series. Toss in a faulty premise, or leave out one huge minimizing parameter, and all the deductions and inductions are meaningless. Garbage in, garbage out even with a high end processor.

          1. This and confirmation bias by the bucket

    2. “…the smartest girls I’ve ever known…”

      Smart does not equal wise. Perhaps you should start thinking of them as idiot savants.

      1. Or excellent wizards with shit Will saving throws.

    3. The key isn’t access–the key is whether or not it will actually result in real cost reductions on healthcare. If healthcare costs keep rising at a 9% clip every year, the IRS is going to be collecting a lot of money in taxes from the uninsured, because no one will be able to afford the plans.

      You should also ask them, if increasing the number of people on health insurance is supposed to lower the cost of healthcare, how come the cost has gone up year after year despite increasing numbers of people on health insurance plans and government medical programs?

      Then show them this article, and ask them what the difference was between the 1950s and today that having a normal birth in a hospital costs damn near 20 times now what it did back then on an inflation-adjusted basis (the nominal cost differences are sickening enough).

      http://www.oftwominds.com/blog…..07-09.html

    4. Well we know they’re gullible….are they hot? If so I’d like to discuss my “health care” plan with them….maybe at the same time!

      1. Well, the woman in Seattle is married with kids and fat (but has a pretty face!). The woman in Michigan has a barrel of disqualifiers, chief among them being a lack of boobs (radical mastectomy), and a wife.

        I’ll put it this way, my husband is not a fan of many of my girlfriends, but he HATES these two women with a passion. He has remained friends on FB with the lesbian because he wants to know when her cancer returns to finish her off. And he likes posting rude shit on her threads. And since she’s nuts, she takes the abuse.

        1. “He has remained friends on FB with the lesbian because he wants to know when her cancer returns to finish her off. And he likes posting rude shit on her threads. And since she’s nuts, she takes the abuse.”

          Pretty sure Trey Parker and Matt Stone could use that material.
          Twice now, you’ve got me laughing when I shouldn’t.

        2. chief among them being a lack of boobs (radical mastectomy), and a wife.

          Sever.

    5. Re: Christina,

      Considering that in both cases I became friends with these girls because we were in TAG/GT classes together, which require 130+ IQ for admission, […] two of the smartest girls I’ve ever known can’t/won’t think about consequences of their political beliefs.

      Maybe they’re smart – maybe. Or maybe there’s some sort of Affirmative Action being applied here of which you’re not yet aware…

  8. I actually doubt that Obamacare will put too much strain on the delivery system. Everyone seems to be proceeding from the assumption that the uninsured are getting no medical care today, which is clearly not the case. They get medical care through charity, emergency room, their own payment, etc. They use slightly less than the insured, but if they break a bone, they get it set, get cancer, they get chemo, etc.

    1. They use slightly less than the insured, but if they break a bone, they get it set, get cancer, they get chemo, etc.

      I’m a 48 yr old who hasn’t seen a doctor (other than “trauma”-cuts requiring stitches/broken bones- all paid “out-of-pocket” on a high deductible plan) since the last of my childhood immunizations.

      If I’m forced to buy insurance that forces me to pay for a “free” annual physical, you can be damned sure I’m making that a priority.

    2. I worry about hypochondriacs if the co-pays are too low. My friends’s girl friend and a few other people I know plus a few of my students every year like to go to the doctor a few times a week when they can afford it.

      If they can go even more cheaply I’m afraid it will be every week. Once it’s government run, how long before they will pass laws that say companies can’t fire people for going to the doctor too much because it’s federal health care. They seem to expand their power into every other area.

  9. So if you provide 40 mil people increased access to doctors and hospitals, but neither the quality or quantity of the doctors and hospitals have increased, people will have tougher time finding doctors?

    Ho.

  10. Of course there will be problems, but Democrats will ameliorate them by blaming the Republicans, the insurance companies, and the providers. Quite simple, really.

    1. In one of the books written by news-folks not long after the ‘opening’ of China (“One Billion”?; not gonna look this evening) there was a chapter on the effects of the Cultural Revolution. You’d (or, I’d) guess that the limitations on information would really screw up the functions of a market.
      Nope. It was pretty common practice to eye the date on the MD’s license; if it was during the CR, why, you simply said ‘no problem’ and tried to go elsewhere.

  11. Those folks seem to know whats going on over there. WOw.

    http://www.IP-Hiding.tk

  12. Is that Indian guy waving the big dildo that ObamaCare is going to fuck us in the ass with?

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