Don’t Blame Health Care Reform for the Old System’s Failures

Opponents of health care reform continue to think up reasons why reform should be canceled before it goes into effect. The latest is the prediction that reform will cause long waits and overcrowding of emergency rooms.

That’s what happened in Massachusetts after that state passed its own health care reform bill in 2006. By 2008, at least 340,000 citizens of Massachusetts were covered by health insurance who had not been covered before. The problem was that there were not enough primary care physicians to take care of 340,000 additional people. One health clinic in Holyoke soon had 1,600 people on a waiting list, and the wait for a first appointment was four months. Those who couldn’t wait went to emergency rooms for care.

So, one reason the Massachusetts health care reform law resulted in crowded emergency rooms is that there were not enough primary care physicians to take care of the people who needed to see doctors. And the fact is, there’s a shortage of primary care physicians just about everywhere in the U.S., especially in more sparsely populated areas. The only thing that’s prevented long waiting lists to see your family doctor is the fact that so many Americans have no insurance and can’t afford to see a doctor.

Why aren’t there enough primary care physicians to go around? The biggest reason is that fewer and fewer medical students are choosing that field of medicine. “Family doctors” work longer hours for less money than many other specialties. These days young doctors leave medical school with $120,000 or more in student loan debt, which makes the higher salaries offered to surgeons and other specialists very appealing. It is especially tempting to go into specialties like sports medicine that mostly serve the wealthy and well-insured.

Primary care physicians also have higher administrative overhead than other doctors. They deal with more insurance company paperwork, such as referrals, than other specialties. They are also the ones to sign notes to employers and school principals about absences, requests for handicapped parking stickers, etc.

For the past several years, the standard “solution” offered by conservatives to alleviate the doctor shortage is “tort reform.” The theory is that the reason there aren’t enough doctors is that physicians are being driven out of medicine by high malpractice insurance costs. But the truth is that many of the specialties attracting younger doctors have much higher malpractice insurance costs than primary care.

Another theory offered by anti-reformers is that if government just got out of the way, the “free market” and the law of supply and demand would eventually even everything out. But in a way, the law of supply and demand has made the problem worse. As more and more Americans lost insurance, the system no longer responded to their health care needs. When “demand” comes only from people with the best insurance and highest income, the system supplies plenty of plastic surgeons and sports medicine specialists but not enough family doctors.

This is a complex issue, and the real solution probably will include education subsidies and other incentives for young doctors to stick to family medicine. And this issue touches on several other issues of particular interest to people suffering from asbestos cancer and other deadly but rare diseases. First, “tort reform” unfairly punishes the people who are most damaged by the negligence or carelessness of others. Second, rare and devastating diseases that are unprofitable to treat would be ignored by a “free market” system.

As the many provisions of the health care reform bill go into effect, we will hit some rough patches. People who oppose reform will use every one of those rough patches as arguments for scrapping reform and going back to the old system. Just remember that the old system seemed to “work” only because so many people were cut off from it by lack of insurance.

This entry was posted on Monday, July 5th, 2010 at 9:31 pm and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.