Category Archives: supply and demand

Mediscare and/or Medifact

A wide range of sources, right, left and center, report a dangerous shortage of doctors under the Affordable Care Act. The numbers of the shortages vary widely. Forbes worries most about physician shortages in the South, and the Mountain West. “Peter Cunningham, author of the study, captures the gist of it in this sentence: “growth in Medicaid enrollment will greatly outpace growth in the number of primary care physicians willing to treat new Medicaid patients.’” “Medicaid’s absurdly low reimbursement rates have led physicians to stop participating in the program…” and even though Medicaid rates rise in 2013 and 2014, they go back to the lower levels in 2015. The experts in the Forbes article feel “the temporary rate increase is likely to have no effect on physician access.” In addition – “Medicaid patients have poor access to specialists – especially the high volume surgical specialists.” This author, Avik Roy, believes we should start with “converting the program to block grants for the states and letting states focus on fully funding care for the truly needy.”
Reuters reported on September 30, 2010 that “the U.S. healthcare reform law will worsen a shortage of physicians as millions of newly insured patients seek care, says the Association of American Medical Colleges.
The numbers:
·         50% worse in 2015 than forecast
·         Old projection – shortage of 39,600, now closer to 63,000 – worsening through 2025
·         Shortage of 33,100 physicians in specialties such as cardiology, oncology, and emergency medicine
The Association calls on Congress to increase funding to train new doctors.
The Daily Caller on 7/9/2012 suggests that 83% of American physicians have considered leaving their practice over President Barack Obama’s health care reform law. (survey from Doctor Patient Medical Association).
The Daily Caller predicts a shortage of 90,000 doctors by 2020 (both from expanded coverage and more Americans living past 65).
They predict that by 2025 the shortage will balloon to over 130,000.
Again quoting the DPMA, co-founder Kathryn Serkes said, “Doctors clearly understand what Washington does not- that a piece of paper that says you are ‘covered’ by insurance or ‘enrolled’ in Medicare or Medicaid does not translate to actual medical care when doctors can’t afford to see patients at the lowball payments, and patients have to jump through government and insurance company bureaucratic hoops.”
Even on TV last week there was a lot of talk about doctor shortages.
Do we think it is better to leave 32 million people without insurance because of logistics?
Doctors cannot be produced quickly – there is no automated plant for turning out doctors – so there probably will be shortages. Will we fill the demand with doctors from other nations? Will we have robot doctors for routine exams? Will technology fill the gaps?
We know that those who can pay more for health insurance will continue to get better care and those who pay the least will get the least care. Will it be better than no care at all? Will it be better than using an emergency room as your primary care physician?
These doctor shortage numbers are factual, but the predictions vary so much. It is entirely possible that they are also being used as Obamascare tactics. Will the supply swell to meet the demand?
I think we will find the Affordable Care Plan is just a starting point. Even if states don’t opt out of it through attitude issues or funding issues or both, it will probably need to be tweaked. We have to start somewhere and this plan is a done deal. Let’s start here.
Here’s what the Republican in my backyard had to say after reading my blog:
I read your blog this morning… I mean really?  All the media organizations, regardless of political leanings are agreeing on the shortage.  Your solution is technology… we are decades from HAL or getting more doctors going to school.  Basic economics are in play here…. (I can graph this with supply & demand curves if you like), but essentially, doctors don’t want to be doctors, because “A” it is not worth the cost to become a doctor and “B” doctors are losing freedom to prescribe what they believe are the best solutions for peoples’ health. 
One of the biggest concerns is the cost of this program.  It isn’t funded and we are all expecting large tax increases… your answer is to pay doctors more…..even more cost… perhaps subsidize their education?… even more cost.   However, one of the rationales for the Obamacare was lowering costs??? So the government is lowering payments to healthcare providers….   You speak about all the people without insurance… those people and more of us that have insurance, are going to have even worse service or no service because of shortage of doctors and other medical professionals.  New drugs and equipment will not be “approved” as rapidly by the government oversight resulting in a decreasing level of care.
Going further, the government running things – Healthcare, is inefficient – i.e…. more expensive than allowing the market to work.  No one is saying there needs to be no rules but the “rules” today have created most of the problems with today’s healthcare quality and cost.   Today, it isn’t possible for me to buy an individual dental plan in NY State.  That is ridiculous.   What is needed is more competition in the insurance market place. 
The other major problem is cost of medical malpractice insurance.  This is a major reason way many doctors want to leave the profession – they can’t make any money.  It is about time for reform here and bringing settlements within reason and end all the frivolous lawsuits.