July 30 2012
Have you ever heard someone say, "I get my health care from my employer." This phraseology has become popular, but what it really means is, "My employer pays for part of or all of my health insurance premium." Unless your employer is also your health care provider - i.e. your doctor - you do not get your health care from your employer.
You don't get your health care from BlueCross either, or Aetna, or United... There's a big difference in health insurance and health care, and if we haven't learned that yet, boy, am I afraid we are about to learn that lesson the hard way in the U.S.
One of ObamaCare's primary goals is universal insurance coverage. Noble goal? Maybe. I'm sure the intentions are good. (Unless of course, those intentions were to satify the insurance lobbyists drooling over millions of mandated new customers.)
The practical problem with insuring millions of new people at once is that of course, only doctors and medical health professionals can actually provide health care. Today the New York Times explores how ObamaCare will make the oncoming shortages of physicians worse:
In the Inland Empire, an economically depressed region in Southern California, President Obama’s health care law is expected to extend insurance coverage to more than 300,000 people by 2014. But coverage will not necessarily translate into care: Local health experts doubt there will be enough doctors to meet the area’s needs. There are not enough now.
Other places around the country, including the Mississippi Delta, Detroit and suburban Phoenix, face similar problems. The Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed. And that number will more than double by 2025, as the expansion of insurance coverage and the aging of baby boomers drive up demand for care. Even without the health care law, the shortfall of doctors in 2025 would still exceed 100,000.
What the Times doesn't explicitly say is that in 2025, the estimated doctor shortage is more than 125,800 with ObamaCare and about 100,000 without (they ask us to do the math, something my journalism teachers told me never to ask readers to do). They did include this graph, though, which illustrates the point.
Please allow me to anticipate your response. "But, but, isn't it worth it if we all sacrifice a little less time with our doctor, to accommodate more patients into our health system?"
Of course everyone wants to see our health system be more capable of treating more patients. But forcing people to buy insurance - or worse, promising them health care through an already strained Medicaid program - isn't the answer.
We need more doctors, for one thing. Healthier individuals would be good too! But in terms of policy, we should be careful to remember that health insurance and health care are not the same thing. Government dictating that certain treatments or drugs should be available without cost doesn't mean they are free. Government mandating that everyone have coverage for more and more services and treatments doesn't mean we will be able to go into the market and find those needed treatments. In health care, "supply" isn't insurance policies. "Supply" is the actual medical professionals, drugs, and devices. We need a greater supply of those things, and more innovative progress in those things - not just a redistribution of them through manipulation of government programs, taxes, reimbursements, or subsidies.
The supply of doctors has been increasing over time, but it's not enough to track with our population growth. Furthermore, among doctors, a rising percentage are pursuing specialty medicine, not general practice. Doctors also tend to congregate in urban centers or places where they can access more technology or peer support. Rural practice presents a host of challenges.
Doctors want nothing more than to be able to treat their patients well. This means enough time with each patient for necessary counseling. Managers across the country are already asking doctors to speed through patient visits to see more patients per day.
It may be politically popular to brag about ObamaCare's gains in the number of insured people. But it is more important that we focus on the quality of care available.