American Elephants

There Won’t Be a Shortage of Doctors, But You won’t Have Access to Them! by The Elephant's Child

“No there won’t be a doctor shortage,” wrote Ezekiel Emanuel MD and Scott Gottlieb MD in the New York Times the other day.

ObamaCare will weather that change just fine. How? Nurses and other paramedic personnel can substitute for physicians and new technology is making remote monitoring of patients easier than ever before.

That’s more in the ‘put on a happy face’ department. Scott Gottlieb is a fellow at AEI, and wrote more accurately under the headline “Obamacare won’t create a shortage of doctors. That doesn’t mean you’ll have access to them.” He says: “While there is unlikely to be a doctor “shortage” for the reasons we argue in the New York Times, that doesn’t mean that the Obamacare plans will enable broad access to these providers. The Obamacare plans are a throwback to the old HMO model that was soundly rejected in the 1990s in favor of PPO style health plans.” He adds:

I found one Obamacare health plan that offers access to only seven pediatricians for a county with 260,000 children.

John Goodman at the National Center for Policy Analysis, however suggests that there are two features of ObamaCare that will substantially increase the demand, while nothing in the law increases supply. When people take steps to increase their access in response to growing waiting times, the success of some will increase the rationing problems for everyone else.

We don’t know how many people will end up insured under ObamaCare, but the administration’s goal was adding 30 million people. When they acquire insurance, economic studies suggest that they will double their use of the health care system.

The health reform law says that health insurance must cover the tests and procedures recommended by the U.S. Preventive Services Task Force. (?) Scholars at Duke University have calculated that arranging for and counseling patients about all those screenings would require 1,773 hours of the average primary care physicians’ time each year, or 7.4 hours per working day. That’s searching for problems and talking about the search. If the screenings turn up something, that’s more hours.

In a normal market, when demand exceeds supply, the price rises until it reaches a market clearing level. But under ObamaCare, Americans do not primarily pay for care with their own money — they pay with time. When demand exceeds supply, doctors have a lot of flexibility about who they see, and they tend to see those patients who pay the highest fee. The patients who pay below-market prices will wait the longest. That includes the elderly and people with subsidized insurance in the ObamaCare exchanges.

Dr. Goodman predicts that concierge medicine will grow rapidly, those who can afford it will have a concierge physician, and we will quickly evolve into a two-tiered health care system with those who can afford it getting more care and better care. The more vulnerable populations may have less access to care than they had before ObamaCare became law. Nice going, Obama.


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