A recent Washington Post piece points toward yet another of the weaknesses of the 2010 Affordable Care Act/Obamacare that will make implementing health care reform a nightmare: the shortage of primary care providers needed to care for an explosion of newly insured individuals.
The WaPo story estimates the looming shortfall at some 30,000 doctors nationwide:
The greatest threat to the health-care overhaul might not be the Supreme Court, which is scheduled to hear challenges to the law next month. Or the shifting alliances of an election year. In the end, it’s more likely to be a lack of medical providers. If the law succeeds in extending health insurance to 32 million more Americans, there won’t be enough doctors to see them. In fact, the anticipated shortfall of primary-care providers, by 2015, is staggering: 29,800….
…The health overhaul, some hoped, would address that issue. But with the health insurance expansion’s $971 billion price tag — and the Obama administration goal to keep the law’s cost under $1 trillion — funds for more slots didn’t turn up.
In the context of a $1 trillion overhaul, the White House’s main effort on this front seems modest: a $167 million sliver of the $15 billion Prevention and Public Health Fund created as part of the health-care law.
“It’s good,” Stream says, “but it’s also a drop in the bucket.”
In Arkansas, Obamacare will add an estimated 328,000 additional people to the rolls of the insured, according to this report (PDF) from the Arkansas Center for Health Improvement (ACHI).
Hey, you know what? That’s not a bad thing, in and of itself! Let’s recognize that, OK? I know this is the Internet, but we don’t have to be furious about everything, all the time. I mean, Christ, I’m not Max Brantley, thank heavens.
Obamacare supporters will want to stop the discussion right there. “Well, people have more access to care, problem solved, hooray!, no further questions,” is what they are saying. But the thing about Obamacare is that, for every OK development it might deliver, there are legions of unanticipated costs and unforeseen consequences. Most of these costs and consequences stem from the hasty, shoddy and incompetent manner in which the bill was developed.
Actually, the doctor shortage doesn’t fit under the heading of “unforeseen consequences,” because if you think about it for about five seconds, you realize it was totally foreseeable. Follow this trail:
You have an existing health care system of doctors and hospitals that provides services to people.
You suddenly introduce millions of additional people into that system, without expanding the system of service providers.
Q: What happens?
A: Longer wait times. Higher costs.
The drafters of the health care reform law couldn’t foresee every potential problem, but this one seems obvious: It’s a pretty standard supply and demand problem relationship.
Massachusetts: The Waiting Game
Let’s go to the data…. Look to Massachusetts, where the closest analogue we have to the Obamacare model was instituted in 2006 by then-Gov. Mitt Romney. Under Romneycare, here’s one thing that happened in the Bay State: wait times to see doctors got a lot longer, according to a 2011 report from the Massachusetts Medical Society. Need to see your doctor for a routine check-up? Hope you’re prepared to wait, oh, 48 days or so.
Here’s Avik Roy laying it down in Forbes:
These surveys point to a key flaw of Obamacare (and Romneycare): that one of the critical ways to improve access and reduce the cost of health care is to increase the supply of doctors and hospitals. If more people have insurance, and the supply of doctors and hospitals remains fixed, the price of health care will go up.
If, on top of that, you go with the four-tranche American system, in which Medicaid (and increasingly Medicare) underpay physicians and hospitals for their time, those are the patient populations for whom health care access is the poorest. Once again, access to health insurance is not the same thing as access to health care.
Roy also notes that, in Massachusetts, emergency room visits grew—in large part because the Bay State health reform law failed to address the need for more providers.
Arkansas’s Future, Today!
You’re wondering how this would affect Arkansas? Why, our best and brightest are working on that right now!
In January, a task force led by the ACHI issued a document titled “Arkansas Health Workforce Strategic Plan: A Roadmap to Change,” (PDF) a draft plan for dealing with the health provider workforce shortage. (ACHI also posted a webinar detailing the report found here, if you’re interested enough in this topic to spend 45 minutes watching.)
You can read it all here (PDF), but here’s the skinny: The shortages of health care providers in Arkansas are already acute, and will only grow worse. From page 7: “The existing health workforce is unable to meet the health needs of Arkansans by almost every measure.”
The draft plan is your standard issue Can-Do Technocratic Scheme, written in the heavily bullet-pointed style of Scheming Can-Do Technocrats everywhere, outlining four key goals for dealing with the shortage of primary care physicians, including a transition to “team-based care,” greater use of health information technology and more.
They’re taking comments on the draft through March 6 before delivering the final plan to Gov. Mike Beebe. Then they have three years to get it all sorted out. Given that six years after Romneycare was passed, Massachusetts still hasn’t sorted it out, I wouldn’t hold my breath about this scheme, either.
UPDATE: On a related note, Roby Brock at Talk Business brings news of a $4.9 million Department of Labor grant to the state of Arkansas to fund training for 1,500 nurses, which will presumably help to lighten the load of health care provision in years to come. So that’s good news!
Now here’s the bad news! That $4.9 million grant is being administered by the state Department of Workforce Services, so the money will most likely be squandered and pissed away by one of the most dysfunctional and poorly managed entities in state government. Oh, well, can’t win ’em all!