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
Add to Briefcase
See more stories about...
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 »
ISIS INVOLVED
Niger Attack Possible Terrorist Set-Up
10 hours ago
THE LATEST

"An emerging theory among U.S. military investigators is that the Army Special Forces soldiers ambushed in Niger were set up by terrorists, who were tipped off in advance about a meeting in a village sympathetic to local ISIS affiliates...The group of American Green Berets and support soldiers had requested a meeting with elders of a village that was seen as supportive of the Islamic State, and they attended the meeting at around 11 a.m. local time Oct. 4...Such meetings are a routine part of the Green Beret mission, but it wasn't clear whether this meeting was part of the unit's plan."

Source:
TRUMP’S COMMENTS AT ISSUE
Bergdahl’s Sentencing Delayed Until Wednesday
10 hours ago
THE LATEST

"The long-awaited sentencing of Army Sgt. Bowe Bergdahl was delayed Monday after a legal battle erupted over the word 'but' in President Donald Trump's most recent remarks about the case. Bergdahl's defense team argued that their client could not get a fair shake from the court because Trump, during a Rose Garden appearance on Oct. 16, at first said he couldn't talk about the case and then added: 'But I think people have heard my comments in the past.'" Trump has called him a traitor and suggested he should be executed.

Source:
PROBE CAME FROM INQUIRY INTO MANAFORT’S FINANCES
Mueller Investigating Tony Podesta and His Firm
19 hours ago
THE LATEST

"Tony Podesta and the Podesta Group are now the subjects of a federal investigation being led by Special Counsel Robert Mueller, three sources with knowledge of the matter told NBC News. The probe of Podesta and his Democratic-leaning lobbying firm grew out of Mueller's inquiry into the finances of former Trump campaign chairman Paul Manafort."

Source:
SCHEDULED FOR TUESDAY
House Intel Will Interview Trump Digital Director
21 hours ago
THE LATEST

"President Donald Trump’s campaign digital director, Brad Parscale, will be interviewed Tuesday by the House Intelligence Committee, his first appearance before any of the panels examining the issue of Russian interference in the 2016 election. Mr. Parscale confirmed his scheduled appearance. The Senate committees also probing interference haven’t scheduled time with Mr. Parscale, he said, declining to comment further."

Source:
CONGRESS MAY HAVE DIFFERENT IDEAS
Trump Promises No Changes to 401(k) Plan
21 hours ago
THE LATEST
×
×

Welcome to National Journal!

You are currently accessing National Journal from IP access. Please login to access this feature. If you have any questions, please contact your Dedicated Advisor.

Login