It’s on the lips of Democratic presidential candidates and on the minds of many voters. But beyond the usual disputes over universal healthcare (taxpayer cost, responsibility, innovation), the harsh reality of implementation is rearing its ugly head in the state of Massachusetts.
There just aren’t enough general physicians to take on the 600,000 uninsured.
Appointments are being scheduled a full year in advance. Older physicians’ retirement have the potential to outnumber incoming, younger physicans. And oh yeah, that aging population of boomers and will soon require even more healthcare.
From the NY Times…
Dr. Patricia A. Sereno, state president of the American Academy of Family Physicians, said an influx of the newly insured to her practice in Malden, just north of Boston, had stretched her daily caseload to as many as 22 to 25 patients, from 18 to 20 a year ago. To fit them in, Dr. Sereno limits the number of 45-minute physicals she schedules each day, thereby doubling the wait for an exam to three months.
“It’s a recipe for disaster,” Dr. Sereno said. “It’s great that people have access to health care, but now we’ve got to find a way to give them access to preventive services. The point of this legislation was not to get people episodic care.”
Whether there is a national shortage of primary care providers is a matter of considerable debate. Some researchers contend the United States has too many doctors, driving overutilization of the system.
If universal healthcare is the answer, how will we prepare to manage the general onslaught of deferred care on top of an already aging population? I haven’t heard much from the candidates on this one. It’s much easier to just use “universal healthcare” as a Democratic battle cry.
Boomers, you’re retirement scares the bejesus out of me. This Atlantic article from January about your impending (and potentially devastating) retirement didn’t do much to calm my young nerves either.
Brother, can you spare a young man a dime?
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If universal healthcare is the answer, how will we prepare to manage the general onslaught of deferred care on top of an already aging population?
And if universal healthcare *isn’t* the answer…? i.e. Going without treatment provides some sort of alternative? I know you don’t think non-treatment is a solution, but the problem with this whole debate is that it often gets phrased in terms of universal healthcare somehow causing problems like not enough doctors. When in fact there already aren’t enough doctors, but those with insurance notice less because of the number of people left out of the system. You see this in the NY Times’ headline: “In Massachusetts, Universal Coverage Strains Care.” Um… really? How about “In Massachusetts a Shortage of Doctors Strains Patients”?
What’s up Unsquished?! Long time, no comment. Good to see you back in the fray!
I must admit that it doesn’t really matter how intensely I desire universal healthcare, if we enter into a healthcare system in this country where my family, friends or I have to wait over a year to see a doctor, I’m gonna be displeased.
My main concern with this post is that when politicians and the media focus only of the end game (”universal healthcare”) we are collectively jumping to the finish line and ignoring many of the problems that could be addressed today. Shouldn’t we be asking and acting on what can be done now to increase the number of doctors in this country, so that the nation isn’t one day stuck in the same uncompromising position of MA?
I’m obviously no expert, but discussing only the end result of universal healthcare seems to be ignoring many of the existing issues that makes this policy simply unpractical today or tomorrow. I hope lawmakers see MA as a test case and try to address the problems today (like fewer doctors) that are a lot less flashy than a cry of “universal care for all!”. While it may not insight the public passion of an all-inclusive healthcare system, these smaller steps would also encounter less resistance in a country where that end-game has become so controversial between the two main political parties.
Good luck finding a solution to this one. Universal healthcare will mean a massive surge in demand for health care of all types, because it will become a market with virtually no price discipline. Now, that should encourage more people to become doctors, because the rise in demand would, absent other forces, cause the financial rewards for getting an MD even more appealing.
But there we have two problems, one short-run and one long-run. The short-run issue is that we can’t mint new MDs as fast as we can offer everyone free health care. The latter takes only the stroke of a president’s pen. The former takes years of training. The long-run problem is even more troublesome. As demand explodes, so will costs of all types, and government will be left to find some way to stem the tide of ever-rising prices. It’s only a matter of time before that means price controls. And price controls only exacerbate supply problems. Throw in the certain steady stream of proposals to reign in costs by regulating what we eat, what we do with our spare time, etc. , and you have a perfect storm of petty interference with everyday freedoms and incoherent economic policy.
All of this is in addition to a simple fact: we can’t afford universal coverage. Even now, we can barely afford Medicare, Medicaid and Social Security. The last of those three is essentially bankrupt; the trust fund is filled with worthless IOUs and the boomers’ retirement can’t be funded by the current generation of workers, absent massive tax increases. And yet we propose to more than double the amounts of these entitlements? I kind of doubt the Chinese and Saudis will have a big enough appetite for Treasury notes to finance that largese. We’re already leveraged to the hilt.