Not enough doctors for Obamacare

[DarrinS]

http://www.cnn.com/2009/HEALTH/08/20...age/index.html

(CNN) -- When President Obama recently cited the number of Americans without health insurance, he declared that, "We are not a nation that accepts nearly 46 million uninsured men, women, and children."

Uninsured patients often delay preventive care, waiting to seek medical attention only when their conditions worsen. This leads to more intensive treatment, often in the emergency department or hospital where costs run the highest.

Universal health coverage is therefore a sensible goal, and the reforms being considered all make considerable effort to provide everyone with affordable health care.

But expanding coverage cannot succeed as long as there remains a shortage of primary care clinicians.

After all, what good is having health insurance if you can't find a doctor to see you?

Massachusetts is often held out as a model for national health reform, and the bills being considered in Washington emulate much of that state's 2006 landmark universal coverage law. As a physician in neighboring New Hampshire, I have had the opportunity to observe the effect of the Massachusetts reforms.

Today, 97 percent of Massachusetts residents have health insurance, the highest in the country. But less publicized are the unintended consequences that the influx of half a million newly insured patients has had on an unprepared primary care system.

The Massachusetts Medical Society reported that the average wait time for a new patient looking for a primary care doctor ranged from 36 to 50 days, with almost half of internal medicine physicians closing their doors entirely to new patients. And when you consider that Massachusetts already has the highest concentration of doctors nationwide, wait times will likely be worse in other, less physician-abundant parts of the country, should universal coverage be enacted federally.

When patients are forced to wait weeks to obtain medical care, they inevitably find their way into the emergency department for treatment that ordinarily can be handled in a doctor's office. Indeed, since health reform was passed, according to state data provided to the Boston Globe, Massachusetts emergency rooms have reported a 7 percent increase in volume, which markedly inflates costs when you consider that emergency room treatment can be up to 10 times more expensive than an office visit for the same ailment.

Alwyn Cassil, a spokeswoman for the nonpartisan Center for Studying Health System Change, told HealthDay News that expanding coverage without improving access to care is a "recipe for failure," as well as unsustainable, "because it will just bankrupt us."

Massachusetts is finding out just how difficult it is to fiscally maintain universal coverage. In part due to soaring health costs, the state Legislature has proposed reducing health benefits for 30,000 legal immigrants and cutting funding to inner-city hospitals like Boston Medical Center, which, according to the Boston Globe, may "force it to slash programs and jeopardize care for thousands of poverty-stricken families."

The success of universal health coverage depends on an adequate supply of primary care providers. But the Association of American Medical Colleges is forecasting a shortage of 46,000 primary care physicians by 2025, a deficit that not only will balloon under any universal coverage measure, but cannot be made up as doctors, nurse prac ioners and physician assistants all gravitate towards more lucrative specialty practice.

It's not only the financial incentives that need to substantially change for primary care to prosper. More important, the working conditions for the physicians already in the field have to improve. A recent survey in the Annals of Internal Medicine found that roughly half of primary care doctors reported practicing in a work environment "strongly associated with low physician satisfaction, high stress ... and [an] intent to leave."

Primary care clinicians routinely face unreasonable time pressures, a chaotic work pace, and bureaucratic impediments. Onerous paperwork requirements that obstruct patient care have to be reduced. And instead of the current system which encourages doctors to rush through as many office visits as possible, physicians who take the time to counsel, guide, and address all of their patients' concerns should be rewarded. Better valuing the doctor-patient relationship will increase satisfaction, not only for physicians, but for their patients as well.

Such solutions, however, have been largely absent from the health reform conversation.

Although it is a moral imperative for every American to have access to health insurance, alleviating the shortage of primary care providers is of equal importance. The prospect of suddenly adding tens of millions of patients to an overburdened primary care system has the potential to make the already dire state of American health care even worse.

[DarrinS]

I've never heard anyone explain how you can add 45+ million new people into the health care system, without a proportionate increase in medical professionals, and not have rationed health care.


On top of that, this is supposed to give us better quality care at lower cost?


And on top of that, you're going to tax the living out of the existing doctors to pay for this (many make over 250K). <-- They probably wouldn't mind if it were offset by a decrease in their medical malpractice insurance.

[TheProfessor]

I assume you agree with the author that healthcare for all is a moral imperative then?

[DarrinS]

I assume you agree with the author that healthcare for all is a moral imperative then?

If health care is a moral imperative, then so are food, water, shelter, and electricty.

[Cry Havoc]

I've never heard anyone explain how you can add 45+ million new people into the health care system, without a proportionate increase in medical professionals, and not have rationed health care.


On top of that, this is supposed to give us better quality care at lower cost?

Maybe not having to pay $250 for a pill that costs 20 cents to make?

And on top of that, you're going to tax the living out of the existing doctors to pay for this (many make over 250K). <-- They probably wouldn't mind if it were offset by a decrease in their medical malpractice insurance.

Oh no! Doctors won't have as much money to afford 3 separate houses in different parts of the country! Everyone should think what we're robbing them of when we give those stupid selfish people the ability to go SEE a doctor.

[DarrinS]

Maybe not having to pay $250 for a pill that costs 20 cents to make?

Has nothing to do with shortage of doctors.

Oh no! Doctors won't have as much money to afford 3 separate houses in different parts of the country! Everyone should think what we're robbing them of when we give those stupid selfish people the ability to go SEE a doctor.

Wow! Doctors make too much money, huh? Do you know how much time and money doctors invest in their education? Do you know how much their student loans are? (hint: you could buy a house in S.A., easy). Do you know how much they pay in malpractice insurance? For everything that physicians go through, I don't think they make nearly enough.

[ChumpDumper]

I've never heard anyone explain how you can add 45+ million new people into the health care system, without a proportionate increase in medical professionals, and not have rationed health care.

Those people are already in the health care system -- the more expensive part -- and care is already rationed.

[SpurNation]

There's a system that already works in the agriculture/farm and ranch industry that could be implemented in the healthcare industry.

Subsidation and Rate Equalization. That along with insurance reform would do wonders for this country's health care problems without it becoming a total government controlled system.

[polysylab1k]

Then the education system is about to follow the health care system en route to a surgery. The government will give privileges to colleges to give their students as many medical degrees as they want, so it won't be a hard job to fill up the gap between demand and supply. If that happens, there will appear some insured people believing in their own curability and obdurately refusing to see doctors, whom they believe will not alleviate but worsen their situations. Then it will be like the grandmas pulling the plugs themselves, the government surely will feel much better in thoughts of morality.

[hope4dopes]

http://www.cnn.com/2009/HEALTH/08/20...age/index.html

Hey.. if you keep bogging us down with reality this pie in the sky will never get off ther ground.

[jack sommerset]

Shocking! 50 more million people and not enough doctors. Say it ain't so. How can this be? Obama is a ing idiotl. When they pass this it will end any tiny bitty little chance he gets another 4 year run.

[George Gervin's Afro]

Shocking! 50 more million people and not enough doctors. Say it ain't so. How can this be? Obama is a ing idiotl. When they pass this it will end any tiny bitty little chance he gets another 4 year run.

Who's treating the 50 million now?

[jack sommerset]

Who's treating the 50 million now?

Why are you asking me such a dumb question? Seriously.

Take a few steps back and think about how ing stupid it is to pay for 50 million people to go to the doctor. We can't afford it. We don't have the money. It really should be that simple.

Think little troll how unfair it is for me and other hard working americans to have some our taxes go to someone esle so they can see a doctor.Do you have a job? Think about how unfair it will be for those people who will lose their jobs because they won't be able to compete with our government. Think how unfair it is for government to decide who gets what,why and when. Think about how our governement has done when they are in charge of anything.

George you really need to use your head. I know you are cheering for your team and want them to succeed but this is a dumb plan. Don't you care that unemployment is up to 9.5 percent. Don't you care that more people cannot pay there mortgage. Do you know the USA owes like a trillion dollars? Seriously..Pay off our debt then lets talk about free healthcare for all the citizens including illegals.

[jack sommerset]

Here is a interesting site.

http://brillig.com/debt_clock/

[DMX7]

"Not enough guns" is what I say.

[polysylab1k]

Why are you asking me such a dumb question? Seriously.

Dumb questions are asked to dumb people.

[jack sommerset]

Dumb questions are asked to dumb people.

George...Ask ^^^^

[George Gervin's Afro]

Why are you asking me such a dumb question? Seriously.

Take a few steps back and think about how ing stupid it is to pay for 50 million people to go to the doctor. We can't afford it. We don't have the money. It really should be that simple.

Think little troll how unfair it is for me and other hard working americans to have some our taxes go to someone esle so they can see a doctor.Do you have a job? Think about how unfair it will be for those people who will lose their jobs because they won't be able to compete with our government. Think how unfair it is for government to decide who gets what,why and when. Think about how our governement has done when they are in charge of anything.

George you really need to use your head. I know you are cheering for your team and want them to succeed but this is a dumb plan. Don't you care that unemployment is up to 9.5 percent. Don't you care that more people cannot pay there mortgage. Do you know the USA owes like a trillion dollars? Seriously..Pay off our debt then lets talk about free healthcare for all the citizens including illegals.

You are already paying for these folks medical care and we have enough doctors to treat them now. if you weren't so blinded by obama hate you'd realize this.

[polysylab1k]

George...Ask ^^^^

You are an IDIOT. Immigrants like you should have stayed in their hometowns before they get any idea about how to lubricate their tongues with their urine.

[boutons_deux]

"Think about how unfair it will be for those people who will lose their jobs because they won't be able to compete with our government"

but it's "fair" for policy holders and docs and their staffs to battle with "those people" about what will be covered, and "fair" to subsidize "those people" with exorbitant, increasing premiums?

"those people"'s priority at for-profit insurance companies is to charge the highest possible prices, which are subsidized by hated federal government, then and deliver the minimum amount product, and where possible, no product at all.

I won't shed a ing tear for them. Do they shed tears for policy holders they cancel or refuse to pay coverage for, or force into lawyers' claws?

[George Gervin's Afro]

"Think about how unfair it will be for those people who will lose their jobs because they won't be able to compete with our government"

but it's "fair" for policy holders and docs and their staffs to battle with "those people" about what will be covered, and "fair" to subsidize "those people" with exorbitant, increasing premiums?

"those people"'s priority at for-profit insurance companies is to charge the highest possible prices, which are subsidized by hated federal government, then and deliver the minimum amount product, and where possible, no product at all.

I won't shed a ing tear for them. Do they shed tears for policy holders they cancel or refuse to pay coverage for, or force into lawyers' claws?

The insurance companies can deny coverage, drop people who get to expensive, and refuse anyone with a pre existing condition. The Obama haters don't have any problem with subsidizing these people now so they are against any reform.

[jack sommerset]

"Think about how unfair it will be for those people who will lose their jobs because they won't be able to compete with our government"

but it's "fair" for policy holders and docs and their staffs to battle with "those people" about what will be covered, and "fair" to subsidize "those people" with exorbitant, increasing premiums?

"those people"'s priority at for-profit insurance companies is to charge the highest possible prices, which are subsidized by hated federal government, then and deliver the minimum amount product, and where possible, no product at all.

I won't shed a ing tear for them. Do they shed tears for policy holders they cancel or refuse to pay coverage for, or force into lawyers' claws?

I shed tears for our country going in to the toliet for ideas and soon to be a reality for things such as free healthcare. We don't have the money. It's that simple.

[George Gervin's Afro]

I shed tears for our country going in to the toliet for ideas and soon to be a reality for things such as free healthcare. We don't have the money. It's that simple.

SO let's just put our heads in the sand and give up!

[jack sommerset]

The insurance companies can deny coverage, drop people who get to expensive, and refuse anyone with a pre existing condition. The Obama haters don't have any problem with subsidizing these people now so they are against any reform.

Fix the insurance companies. And don't think for one second government run healthcare won't deny people either because things get expensive. I say they will deny a of alot more.

[jack sommerset]

SO let's just put our heads in the sand and give up!

Dude....That is nuts to think because people donot want free healthcare that we our putting our heads in the sand and doing nothing. We can't afford it. Fix the our economy. Until then those people who can't or won't pay for healthcare should go to the emergency room when something bad really happens to to them. And there are some free clinics out there.It's a tough world. You actually have to pay for someone to help you. It truly is a shame.