Friday, August 24, 2012

Why It Is Going to Be Much More Difficult to See a Doctor Beginning in 2014

John Goodman, president of the National Center for Policy Analysis, recently wrote in WSJ:
Are you having trouble finding a doctor who will see you? If not, give it another year and a half. A doctor shortage is on its way.

Most provisions of the Obama health law kick in on Jan. 1, 2014. Within the decade after that, an additional 30 million people are expected to acquire health plans—and if the economic studies are correct, they will try to double their use of the health-care system.

Meanwhile, the administration never seems to tire of reminding seniors that they are entitled to a free annual checkup. Its new campaign is focused on women. Thanks to health reform, they are being told, they will have access to free breast and pelvic exams and even free contraceptives. Once ObamaCare fully takes effect, all of us will be entitled to a long list of preventive services—with no deductible or copayment.

Here is the problem: The health-care system can't possibly deliver on the huge increase in demand for primary-care services. The original ObamaCare bill actually had a line item for increased doctor training. But this provision was zeroed out before passage, probably to keep down the cost of health reform. The result will be gridlock.

Take preventive care. ObamaCare says that health insurance must cover the tests and procedures recommended by the U.S. Preventive Services Task Force. What would that involve? In the American Journal of Public Health (2003), scholars at Duke University calculated that arranging for and counseling patients about all those screenings would require 1,773 hours of the average primary-care physician's time each year, or 7.4 hours per working day.
Got that 30 million people will receive expanded care, including "preventive" care?

At the same time, many doctors plan to retire early rather than deal with medical restrictions and bureaucratic paper work that they would have to deal with. Further, the powerful American Medical Association will see to it that no new medical schools will open in the country. It is a prescription for disaster.

More significant, I fully expect that some time down the road, especially if there is a second Obama Administration, the government caused doctor crisis will result in A:LL doctors being forced to take as patients those that use government insurance. This, of course, will result in these doctors being forced to charge only what the government will allow. The result: Even more doctors leaving the field.

The wait to see a doctor will climb with every doctor that leaves the industry. Goodman explains:
Bottom line: To meet the promise of free preventive care nationwide, every family doctor in America would have to work full-time delivering it, leaving no time for all the other things they need to do.

When demand exceeds supply in a normal market, the price rises until it reaches a market-clearing level. But in this country, as in other developed nations, Americans do not primarily pay for care with their own money. They pay with time.

How long does it take you on the phone to make an appointment to see a doctor? How many days do you have to wait before she can see you? How long does it take to get to the doctor's office? Once there, how long do you have to wait before being seen? These are all non-price barriers to care, and there is substantial evidence that they are more important in deterring care than the fee the doctor charges, even for low-income patients.

For example, the average wait to see a new family doctor in this country is just under three weeks, according to a 2009 survey by medical consultancy Merritt Hawkins. But in Boston, Mass.—which enacted a law under Gov. Mitt Romney that established near-universal coverage—the wait is about two months.


  1. Assuming this is all correct, it is fine with me. I welcome reform. I waited two months to see a doctor at a county-run clinic, because other doctors do not take uninsured patients. I paid for the visit, and not at a low rate since I did not go there based on income. Yes, I and my money were refused at my doctor of choice, due to lack of insurance. It's been a hard road to change my way of thinking, but the bottom line is this - if Americans want medical care that is not corrupted by the system, they must move to another country. The alternative is what I chose, and that is to not use America's medical care at all. Twelve years ago when my insurance premium nearly quadrupled due to my need and use of care, I went to a lawyer who told me I'd better keep the insurance due to my conditions. I did not. And I am still here. In America, medical care is treated by the system as a discretionary luxury, priced many times above its value. If we treated it the same as the idea of hiring maids, butlers, drivers, etc., we would see real reform. Few people can afford those servants; why should they purchase into a corrupt system that provides far less than those at many times the price?

  2. Since doctors are products of the government subsidized AMA guild, we'd probably be much healthier if no one ever went to a licensed doctor. With health improving due to this, the government will mistakenly credit socialized medicine, when instead it is the greater use of placebo that improves health. I played catcher and delivered my last two babies without a doctor, and you realize just how little value they are when it is so much better without them.

  3. I am a doctor who's father charged $20 for a visit. Now I am "participating" in Medicare and charge over $100 for the same visit. But, that was before the government got involved with medicine. That's what's changed for Phoebiann. He's obviously not medicare age so he's squeezed out. Now they want to include everyone starting '14 into a system that's unsustainable. Get the government out of medicine and insurance and see Robert Higgs on the FDA and your eyes will be opened to what they've done to our healthcare system.