Investor’s Business Daily, April 23, 2010
President Barack Obama’s health care bill aims to achieve universal coverage while at the same time reducing costs. In reality, this contradictory strategy will ensure that Americans enjoy less health care, of poorer quality, and from fewer doctors.
And while the full effects of ObamaCare might not be felt until Tax Day 2014, the promise of free health care to millions of Americans will begin to prove hollow long before then.
Already Rep. Henry Waxman, D-Calif., says the public option might not be dead if insurance companies do not offer competitive rates within the exchanges. And Sen. Tom Harkin, D-Iowa, has revived a proposal that gives the secretary of health and human services the power to review premiums and block any rate increase bound to be “unreasonable.”
America’s primary care system is already under stress. Low reimbursement rates, bureaucratic paperwork and long hours are driving family physicians out of medicine and pushing new doctors into specialized practices. Half a century ago, one in two doctors practiced general medicine. Today, 7 in 10 specialize.
And the gap is growing. A mere 1 in 12 medical-school graduates now head to family medicine. In 2009, the American Academy of Family Physicians warned that we’d be short 40,000 family doctors in a decade, if present trends continued. Today, medical schools produce one primary care doctor for every two who are needed.
ObamaCare will add strain to an already burdened system. The new bill seeks to increase the load on family doctors while holding the line on costs by putting price controls on government insurance plans. In due course, price controls on private plans will be inevitable.
We saw them come into effect on April 1 in Massachusetts, when the state Division of Insurance rejected 235 of 274 premium increases proposed by insurers for individuals and small businesses. The rate increases — ranging from 8% to 32% — were deemed excessive.
The combination of increased coverage and emphasis on primary care, experts say, will increase demand for primary care docs by as much as 29%, or 44,000 doctors, over the next 15 years.
But just as demand is increasing, doctors are making plans to exit. A 2009 survey by medical recruiters Merritt Hawkins found that 10% of respondents were planning to leave medicine within three years.
Another poll of physicians conducted in 2009 by Investor’s Business Daily found that 45% of doctors would consider early retirement if ObamaCare passed.
Even more worryingly, the next generation of doctors may be even smaller than the current one. The same IBD study found that two-thirds of practicing physicians believed that fewer students would apply to medical school if Obama’s health care plan passed.
If supply is constant — or goes down — and demand increases, one of two things must happen. The price paid per unit of service must increase. Or bureaucrats will control prices, lines will form, services will disappear and rationing will result.
This is what’s happening in the Bay State, the laboratory that spawned Obama’s plan. Since Massachusetts’s 2006 reform, 440,000 people have been added to the insurance rolls, including Medicaid or government-funded plans.
Yet even freshly armed with insurance, many have struggled to find a doctor. Many doctors have quit, retired or moved out of state. A family care doctor in Amherst told NPR in 2008 that 18 of her colleagues left in the wake of Massachusetts’ reform. One clinic in Western Massachusetts has a waiting list of 1,600 patients.
Now bureaucrats have responded by explicitly controlling prices. Shortages will grow. The Bay State’s response is to impose a giant government-dominated HMO — lovingly called a system of global capitated payments.
What doctors should know and patients will soon understand is that the push for reform is really a return to HMO-style managed care — this time called “coordinated care” and explicitly dominated by the federal government. This system, tried in the 1980s, was disliked by patients and physicians alike.
Patients did not like restrictions on making appointments directly with specialists and the perverse incentive that their doctors made more income if patients received less comprehensive care. Doctors chafed under bureaucratic micromanagement. Academics and bureaucrats liked and still like it. So it’s back with a new name.
The problem: Where will the docs come from? They may start coming from the bottom of the class. Or as happened in Canada under a medical system that disallows private health care, it may become cheaper to bring in International Medical Graduates from abroad than to train America’s best and brightest at our own medical schools. After all, being a physician under this system will be just another government job.
Most professors in medical schools and teaching hospitals, as opposed to physicians in private practice, favor a single-payer health care system.
The Benjamin Rush Society for medical students and doctors, named after one of the Founding Fathers and modeled after the Federalist Society, held its first four debates at medical schools last year. At Columbia, Harvard, George Washington, and Texas A&M, fully 65% of the students in the pre-vote supported a single-payer system. In the post-vote, these numbers declined in every instance but one.
It will be extremely difficult to get doctors to oppose a government-run system if they do not know there is an alternative that is in the best interest of not only doctors but patients as well.
• Pipes is president and CEO of the Pacific Research Institute and founder of the Benjamin Rush Society. She is the author of “The Top Ten Myths of American Health Care.”