With the Supreme Court affirming the constitutionality of the Affordable Care Act, it is estimated that another 30 million Americans will have coverage for medical care. Though this may be considered progress towards the goal of universal coverage, it’s unclear who will be providing the care for all of these new patients. The fact there will be inadequate numbers of health care providers seems to have slipped below the radar.
According to a recent Kaiser report on Massachusetts Health Care Reform, which is quite similar to the ACA, one of five patients had trouble finding a physician who would see them after the reform plan was instituted. Average wait-times to see an internist grew by 82% for new patients. 36 days on average was required to obtain an appointment with a family medicine doctor and 48 days for an internist. And this was in Massachusetts, a physician rich state. It can be assumed that physician access will be even more difficult in other areas. Indeed, a national survey last year revealed that 57% of sick patients around the country were unable to promptly gain access to care.
Independent of the Affordable Care Act, as America’s population has been aging and growing, there has been a greater demand for medical care. The epidemic of diabetes, obesity, hypertension and vascular disease also drives the need for care. But with all of this, there have been fewer adult primary care providers available (family practitioners, internists, nurse practitioners and physician assistants) to service patients. And this imbalance between primary health care providers and demand will be exacerbated when a surge of new patients enters the health care system under the ACA.
Fewer medical students have been choosing primary care because the practice is difficult, with long hours and the stress of seeing many patients in brief visits. And remuneration is poor for the work performed, with family care physicians and internists earning among the lowest incomes for physicians. This makes it hard to pay off educational loans and support a family. Specialty practices are much more rewarding financially and less stressful. Many primary care physicians (PCPs) in their 60s and 70s have also been retiring without people to step in and take their places.
The Affordable Care Act has increased incentives to attract medical students to primary care and keep them in this field. Starting in 2011, there was a 10% increase in fees for treatment of Medicare patients by PCPs and Medicaid fees will rise in 2013. However, much more needs to be done to improve access to care. Having enough providers and improving the care of chronically ill patients can reduce costs for the health care system in the long run.
First of all, the medical education for students going into primary care should be subsidized so they will not have to deal with debilitating loans. Secondly, physician assistants and nurse practitioners should also receive financial help with their education, as many more of these indispensable individuals are necessary to provide care for an expanding population. Thirdly, there needs to be further increases in remuneration for all primary care services, including time spent with patients in discussions of lifestyle issues. By dealing with the factors contributing to chronic illnesses, this can in fact be quite valuable in cutting health care costs.
While following the above prescriptions may temporarily increase health care spending, they will save money over time and make it easier for patients to obtain access to the care they need.
Resurrecting Democracy
A VietNam vet and a Columbia history major who became a medical doctor, Bob Levine has watched the evolution of American politics over the past 40 years with increasing alarm. He knows he’s not alone. Partisan grid-lock, massive cash contributions and even more massive expenditures on lobbyists have undermined real democracy, and there is more than just a whiff of corruption emanating from Washington. If the nation is to overcome lockstep partisanship, restore growth to the economy and bring its debt under control, Levine argues that it will require a strong centrist third party to bring about the necessary reforms. Levine’s previous book, Shock Therapy For the American Health Care System took a realist approach to health care from a physician’s informed point of view; Resurrecting Democracy takes a similar pragmatic approach, putting aside ideology and taking a hard look at facts on the ground. In his latest book, Levine shines a light that cuts through the miasma of party propaganda and reactionary thinking, and reveals a new path for American politics. This post is cross posted from his blog.
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Political junkie, Vietnam vet, neurologist- three books on aging and dementia. Book on health care reform in 2009- Shock Therapy for the American Health Care System. Book on the need for a centrist third party- Resurrecting Democracy- A Citizen’s Call for a Centrist Third Party published in 2011. Aging Wisely, published in August 2014 by Rowman and Littlefield. Latest book- The Uninformed Voter published May 2020