ABC News: Hey, This Doctor Shortage Could "Crash" Obamacare

Posted: Nov 15, 2012 9:41 AM

Just in case the unaffordable price tag and rising costs don't quite do the trick, America's spiraling dearth of doctors will contribute heavily to the collapse of our re-engineered health care system, according to a new study:

The United States will require at least 52,000 more family doctors in the year 2025 to keep up with the growing and increasingly older U.S. population, a new study found. The predictions also reflect the passage of the Affordable Care Act -- a change that will expand health insurance coverage to an additional 38 million Americans. "The health care consumer that values the relationship with a personal physician, particularly in areas already struggling with access to primary care physicians should be aware of potential access challenges that they may face in the future if the production of primary care physicians does not increase," said Dr. Andrew Bazemore, director of the Robert Graham Center for Policy Studies in Primary Care and co-author of the study published Monday in the Annals of Family Medicine. Stephen Petterson, senior health policy researcher at the Robert Graham Center, said the government should take steps -- and quickly -- to address the problem before it gets out of hand. "There needs to be more primary care incentive programs that give a bonus to physicians who treat Medicaid patients in effort to reduce the compensation gap between specialists and primary care physicians," said Petterson, who co-authored the study with Bazemore.

But such changes may be more easily said than done. The problem does not appear to be one of too few doctors in general; in fact, in 2011 a total of 17,364 new doctors emerged from the country's medical schools, according to the Association of American Medical Colleges (AAMC). Too few of these doctors, however, choose primary care as a career -- an issue that may be worsening. In a 2008 census by the AAMC and the American Medical Association, researchers found that the number of medical graduates choosing a career in family medicine dropped from 5,746 in 2002 to 4,210 in 2007 -- a drop of nearly 27 percent. "It's pretty tough to convince medical students to go into primary care," said Dr. Lee Green, chair of Family Medicine at the University of Alberta, who was not involved with the study. Green added that he believes this is because currently primary care specialties are not well paid, well treated or respected as compared to subspecialists. "They have to think about their debt," he said. "There are also issues of how physicians are respected and how we portray primary care to medical students." These problems loom even larger considering the aim of the Affordable Care Act to provide all Americans with health insurance -- and with it, more regular contact with a primary care doctor.

A maddening pattern: When the government exacerbates problems, many frustrated observers reflexively call for even more federal intervention to mop up the federally-caused mess.  The solution to big government run amok is more government involvement, apparently.  And before you object to the premise that Obamacare is responsible for the deterioration of our doctor shortage ("this was already becoming a problem before the law was passed," etc), examine the data, including surveys of American doctors.  Come to think of it, beyond the obvious and laudable humanitarian reasons, why would an ambitious young college student pursue a career in medicine when he or she could go to law school and make a fine living suing the daylights out of doctors?  Meaningful tort reform was conspicuously omitted from Obamacare, thanks to the efforts of the trial lawyers' lobby -- a deep-pocketed Democratic constituency.  This ABC News story, authored by a medical doctor, also describes why Romneycare (yeah, remember that?) is a microcosm of brewing larger-scale problems:

Perhaps the best known example of this approach has been Massachusetts, which since 2006 has mandated that every resident obtain health insurance and those that are below the federal poverty level gain free access to health care. But although the state has the second-highest ratio of primary care physicians to population of any state, they are struggling with access to primary care physicians. Dr. Randy Wexler of The John Glenn Institute of Public Service and Policy said he has concerns that this trend could be reflected nationwide. "Who is going to care for these people?" he said. "We are going to have problems just like Massachusetts. [They] are struggling with access problems; it takes one year to get into a primary care physician. Coverage does not equal access." Some have already proposed solutions to this looming problem. One suggestion is that non-physician medical professionals, such as nurse practitioners and physician assistants, can pick up the slack. Doctors, however, said his may not be enough to fill the gap.  

The distinction between nominal "coverage" and actual care was a central argument against Obamacare during the battles of 2009 and 2010.  And as we know all too well, Romneycare is essentially a pilot program for the entire nation.  It has spiked costs, failed to reduce uncompensated care, and resulted in tax increases.  Plus, Massachusetts is plagued by this exact doctor shortage issue -- despite being one of the wealthiest states in the country. In places like Canada, citizens are entitled to universal, "free" coverage, but people languish on waiting lists for care, and sometimes resort to lotteries for the chance sign up with a primary care physician.  Now that Obamacare is more or less here to stay, Americans had better get accustomed to rationing and waiting.  More cracks in Obamacare's facade will appear as the law is fully implemented over the next two years, ultimately culminting in the program's implosion.  Liberals are already making pre-emptive excuses for the White House, asking questions such as, "gosh, is this enterprise just too big for the administration to handle?"

By the end of this week, states must decide whether they will build a health-insurance exchange or leave the task to the federal government. The question is, with as many as 17 states expected to leave it to the feds, can the Obama administration handle the workload. “These are systems that typically take two or three years to build,” says Kevin Walsh, managing director of insurance exchange services at Xerox. “The last time I looked at the calendar, that’s not what we’re working with.” When Walsh meets with state officials deciding whether to build a health exchange, he brings a chart. It outlines how to build the insurance marketplace required under the Affordable Care Act. To call it complex would probably be an understatement...A health exchange’s first task is ensuring that those who are eligible for benefits know about them — right now, research suggests three-quarters have no idea. That suggests a huge outreach challenge — and one the federal government may not be ideally suited to completing. Evidence suggests that it works better when it caters to local markets.  

The federal government passed a massive piece of legislation that included a voluminous labyrinth of new regulations -- and they might not get it up and running on schedule?  Knock me over with a feather.  Perhaps the administration should have considered whether its governing apparatus was "ideally suited" to complete core tasks before locking them into place with a law that personally affects tens of millions of Americans.  Basic competence should be a key initial threshold question, no?  (For more on federal ineptitude and priorities, read this).  Meanwhile, the population remains opposed to Obamacare.  While ABC's new poll indicates that public opposition may be slackening a bit, the latest Rasmussen national poll of registered voters (their major polling flaw this fall was their likely voter party ID weighting) continues to show majority support for repeal -- an outcome that even most of last Tuesday's D+6 electorate said they would support.  The, er, "good" news is that if and when Obamacare's unsustainability proves to be undeniable, liberals will swoop in with the Statist fix they've been angling for all along: