It’s Hard to See Your Doctor. Is That Obamacare’s Fault?

Critics claim the health law will exacerbate the nation’s physician shortage, but a closer look reveals a more complex issue.

a doctor tends to a patient in the US health care system
National Journal
Clara Ritger
Jan. 24, 2014, 12:05 a.m.

Re­pub­lic­ans prom­ise Obama­care will have you wait­ing weeks to see your doc­tor. One web­site says it can get you an ap­point­ment in 24 hours.

Zoc­Doc, a free on­line ap­point­ment-book­ing plat­form, al­lows pa­tients to sched­ule last-minute doc­tor ap­point­ments by filling can­celed or un­booked spots. The com­pany launched in 2007, but it’s bet­ting its ser­vices will be in new de­mand as the Af­ford­able Care Act takes ef­fect.

The health care law aims to ex­tend in­sur­ance cov­er­age to 25 mil­lion new pa­tients over the next dec­ade, and that would — by design — cre­ate new de­mand for primary-care doc­tors. But those are already in short sup­ply, and crit­ics warn that the in­flux of new cus­tom­ers will ex­acer­bate long wait times.

If it works, Zoc­Doc and oth­er sites like it would ease the strain on the primary-care sys­tem, as every last-minute ap­point­ment means one few­er pa­tient in the wait­ing line. But even at their best, such sites would ad­dress only a small piece of the cent­ral prob­lem: The na­tion has too many pa­tients and not enough doc­tors.

Ex­perts are di­vided over wheth­er that prob­lem ex­ists be­cause of Obama­care, or in spite of it.

Ju­lia Para­dise, an as­so­ci­ate dir­ect­or at the non­par­tis­an Kais­er Fam­ily Found­a­tion, says oth­er factors are mostly to blame.

“Pop­u­la­tion growth ac­counts for close to two-thirds of the doc­tor short­age, with aging 19 per­cent and ex­pan­sion 15 per­cent,” Para­dise said, cit­ing a study pub­lished in The An­nals of Fam­ily Medi­cine. “The real­ity is that the strains in the sys­tem didn’t be­gin with the Af­ford­able Care Act. People with very good health in­sur­ance can’t al­ways get ac­cess to ser­vices when they need it.”

Para­dise says geo­graph­ic maldis­tri­bu­tion — the con­cen­tra­tion of phys­i­cians in par­tic­u­lar, of­ten more-af­flu­ent urb­an and sub­urb­an areas — is a sys­tem­ic prob­lem that has al­ways been a bar­ri­er to care for res­id­ents of poor or re­mote neigh­bor­hoods.

Obama­care is at­tempt­ing to ad­dress the doc­tor short­age by sweet­en­ing the pot for med­ic­al stu­dents who go in­to primary care, a dis­cip­line less luc­rat­ive than many spe­cial­ties. In the hopes of clos­ing that gap, the law boosts pay­ments for primary-care doc­tors for two years.

It’s also in­centiv­iz­ing re­forms to pay­ment sys­tems, en­cour­aging doc­tors to provide bet­ter health out­comes the first time a pa­tient walks in the door, and pen­al­iz­ing for read­mis­sions at hos­pit­als.

“Telemedi­cine can ex­tend primary care in ways that wasn’t avail­able to us be­fore,” Para­dise ad­ded.

But crit­ics of the law are skep­tic­al that those pro­vi­sions can make up for the in­flux of new pa­tients.

Grace-Mar­ie Turn­er, pres­id­ent of the free-mar­ket-ori­ented Ga­len In­sti­tute, said the two years of high­er pay for primary-care doc­tors isn’t enough to get someone to go to med­ic­al school. And, she said, the reg­u­la­tions are cre­at­ing a pa­per­work bur­den for doc­tors who are wor­ried about get­ting pen­al­ized.

“We need to let doc­tors do what they do, which is take care of pa­tients,” Turn­er said. “But the third-party pay­ment sys­tem has got­ten so deeply in­grained in mi­cro­man­aging doc­tors that they can’t do their jobs. I worry about the wait­ing lines.”

Oth­er al­tern­at­ives, such as al­low­ing nurses to per­form some tasks typ­ic­ally handled by doc­tors, have also come un­der fire.

“If you have a lot of people wind up prac­ti­cing bey­ond their ex­pert­ise, the pa­tient is go­ing to be harmed by that,” Turn­er said. “Politi­cians are not the right people to be mak­ing de­cisions about health care. The in­dustry is.”

Con­sumers wait more than 20 days on av­er­age to see a doc­tor, ac­cord­ing to a 2009 sur­vey from Texas med­ic­al con­sult­ing firm Mer­ritt Hawkins and As­so­ci­ates. That num­ber is ex­pec­ted to rise giv­en what happened in Bo­ston after Mas­sachu­setts im­ple­men­ted its own health re­form years be­fore the Af­ford­able Care Act was passed. The av­er­age wait time for a doc­tor’s ap­point­ment, the sur­vey found, is 50 days. While wait times will vary across the coun­try, Mas­sachu­setts could be the crys­tal ball of the fu­ture.

What We're Following See More »
STAFF PICKS
When It Comes to Mining Asteroids, Technology Is Only the First Problem
2 days ago
WHY WE CARE

Foreign Policy takes a look at the future of mining the estimated "100,000 near-Earth objects—including asteroids and comets—in the neighborhood of our planet. Some of these NEOs, as they’re called, are small. Others are substantial and potentially packed full of water and various important minerals, such as nickel, cobalt, and iron. One day, advocates believe, those objects will be tapped by variations on the equipment used in the coal mines of Kentucky or in the diamond mines of Africa. And for immense gain: According to industry experts, the contents of a single asteroid could be worth trillions of dollars." But the technology to get us there is only the first step. Experts say "a multinational body might emerge" to manage rights to NEOs, as well as a body of law, including an international court.

Source:
STAFF PICKS
Obama Reflects on His Economic Record
2 days ago
WHY WE CARE

Not to be outdone by Jeffrey Goldberg's recent piece in The Atlantic about President Obama's foreign policy, the New York Times Magazine checks in with a longread on the president's economic legacy. In it, Obama is cognizant that the economic reality--73 straight months of growth--isn't matched by public perceptions. Some of that, he says, is due to a constant drumbeat from the right that "that denies any progress." But he also accepts some blame himself. “I mean, the truth of the matter is that if we had been able to more effectively communicate all the steps we had taken to the swing voter,” he said, “then we might have maintained a majority in the House or the Senate.”

Source:
STAFF PICKS
Reagan Families, Allies Lash Out at Will Ferrell
2 days ago
WHY WE CARE

Ronald Reagan's children and political allies took to the media and Twitter this week to chide funnyman Will Ferrell for his plans to play a dementia-addled Reagan in his second term in a new comedy entitled Reagan. In an open letter, Reagan's daughter Patti Davis tells Ferrell, who's also a producer on the movie, “Perhaps for your comedy you would like to visit some dementia facilities. I have—I didn’t find anything comedic there, and my hope would be that if you’re a decent human being, you wouldn’t either.” Michael Reagan, the president's son, tweeted, "What an Outrag....Alzheimers is not joke...It kills..You should be ashamed all of you." And former Rep. Joe Walsh called it an example of "Hollywood taking a shot at conservatives again."

Source:
PEAK CONFIDENCE
Clinton No Longer Running Primary Ads
2 days ago
WHY WE CARE

In a sign that she’s ready to put a longer-than-ex­pec­ted primary battle be­hind her, former Sec­ret­ary of State Hil­lary Clin­ton (D) is no longer go­ing on the air in up­com­ing primary states. “Team Clin­ton hasn’t spent a single cent in … Cali­for­nia, In­di­ana, Ken­tucky, Ore­gon and West Vir­gin­ia, while” Sen. Bernie Sanders’ (I-VT) “cam­paign has spent a little more than $1 mil­lion in those same states.” Meanwhile, Sen. Jeff Merkley (D-OR), Sanders’ "lone back­er in the Sen­ate, said the can­did­ate should end his pres­id­en­tial cam­paign if he’s los­ing to Hil­lary Clin­ton after the primary sea­son con­cludes in June, break­ing sharply with the can­did­ate who is vow­ing to take his in­sur­gent bid to the party con­ven­tion in Phil­adelphia.”

Source:
CITIZENS UNITED PT. 2?
Movie Based on ‘Clinton Cash’ to Debut at Cannes
2 days ago
WHY WE CARE

The team behind the bestselling "Clinton Cash"—author Peter Schweizer and Breitbart's Stephen Bannon—is turning the book into a movie that will have its U.S. premiere just before the Democratic National Convention this summer. The film will get its global debut "next month in Cannes, France, during the Cannes Film Festival. (The movie is not a part of the festival, but will be shown at a screening arranged for distributors)." Bloomberg has a trailer up, pointing out that it's "less Ken Burns than Jerry Bruckheimer, featuring blood-drenched money, radical madrassas, and ominous footage of the Clintons."

Source:
×