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 »
LEGACY PLAY
Sanders and Clinton Spar Over … President Obama
5 hours ago
WHY WE CARE

President Obama became a surprise topic of contention toward the end of the Democratic debate, as Hillary Clinton reminded viewers that Sanders had challenged the progressive bona fides of President Obama in 2011 and suggested that someone might challenge him from the left. “The kind of criticism that we’ve heard from Senator Sanders about our president I expect from Republicans, I do not expect from someone running for the Democratic nomination to succeed President Obama,” she said. “Madame Secretary, that is a low blow,” replied Sanders, before getting in another dig during his closing statement: “One of us ran against Barack Obama. I was not that candidate.”

THE 1%
Sanders’s Appeals to Minorities Still Filtered Through Wall Street Talk
7 hours ago
WHY WE CARE

It’s all about the 1% and Wall Street versus everyone else for Bernie Sanders—even when he’s talking about race relations. Like Hillary Clinton, he needs to appeal to African-American and Hispanic voters in coming states, but he insists on doing so through his lens of class warfare. When he got a question from the moderators about the plight of black America, he noted that during the great recession, African Americans “lost half their wealth,” and “instead of tax breaks for billionaires,” a Sanders presidency would deliver jobs for kids. On the very next question, he downplayed the role of race in inequality, saying, “It’s a racial issue, but it’s also a general economic issue.”

DIRECT APPEAL TO MINORITIES, WOMEN
Clinton Already Pivoting Her Messaging
7 hours ago
WHY WE CARE

It’s been said in just about every news story since New Hampshire: the primaries are headed to states where Hillary Clinton will do well among minority voters. Leaving nothing to chance, she underscored that point in her opening statement in the Milwaukee debate tonight, saying more needs to be done to help “African Americans who face discrimination in the job market” and immigrant families. She also made an explicit reference to “equal pay for women’s work.” Those boxes she’s checking are no coincidence: if she wins women, blacks and Hispanics, she wins the nomination.

THE QUESTION
How Many Jobs Would Be Lost Under Bernie Sanders’s Single-Payer System?
15 hours ago
THE ANSWER

More than 11 million, according to Manhattan Institute fellow Yevgeniy Feyman, writing in RealClearPolicy.

Source:
WEEKEND DATA DUMP
State to Release 550 More Clinton Emails on Saturday
15 hours ago
THE LATEST

Under pressure from a judge, the State Department will release about 550 of Hillary Clinton’s emails—“roughly 14 percent of the 3,700 remaining Clinton emails—on Saturday, in the middle of the Presidents Day holiday weekend.” All of the emails were supposed to have been released last month. Related: State subpoenaed the Clinton Foundation last year, which brings the total number of current Clinton investigations to four, says the Daily Caller.

Source:
×