Learning the hard way

Massachusetts is seeing another problem that can happen when public healthcare policies are based on feel good politics, rather than careful examinations of the facts and correctly defining the problems they profess to hope to solve. We could have predicted this...and, in fact, did less than two months ago.

‘Free universal health care for all’ sounds great only if you don’t look around, dig deep or think too much. Massachusetts’ statewide universal healthcare coverage mandate went into effect three weeks ago and already the State has realized it hadn’t accurately identified the uninsured, that their financial projections and how they would pay for their program weren’t even close, and now, that they really goofed in identifying the problem to begin with!

Health insurance is not the same as access to care. The state mandate doesn't address access. In fact, as seen in other single-payer systems, healthcare monopolies worsen the problem of who will provide the care. State regulations and cost-containing efforts drive away healthcare providers and leave shortages of providers, rationing of available resources, and growing waits for care. As the Wall Street Journal reports today:

Doctor Shortage Hurts A Coverage-for-All Plan

...Earlier this month, [Tamar Lewis] signed up for state-subsidized insurance under a new Massachusetts law that aspires to universal coverage. The plan costs her $80 a month. But it takes a lot more than an insurance card to see a doctor in this state. On the day Ms. Lewis signed up, she said she called more than two dozen primary-care doctors approved by her insurer looking for a checkup. All of them turned her away.

Her experience stands to be common among the 550,000 people whom Massachusetts hopes to rescue from the ranks of the uninsured. They will be seeking care in a state with a "critical shortage" of primary-care physicians, according to a study by the Massachusetts Medical Society released yesterday, which found that 49% of internists aren't accepting new patients. Boston's top three teaching hospitals say that 95% of their 270 doctors in general practice have halted enrollment.

For those residents who can get an appointment with their primary-care doctor, the average wait is more than seven weeks, according to the medical society, a 57% leap from last year's survey.... “Health reform won't mean anything for the state's poor if they can't get a doctor's appointment," says Elmer Freeman, director of the Center for Community Health, Education, Research and Service in Boston.... State officials have acknowledged the problem. “Health-care coverage without access is meaningless," Gov. Deval Patrick said in March.

As it happens, primary-care doctors, including internists, family physicians, and pediatricians, are in short supply across the country.... A principal reason: too little money for too much work.... The advent of managed care in the mid-1990s added to the burden as insurance companies called on primary-care doctors to serve as gatekeepers for their patients' referrals to specialty medicine.

Ms. Lewis, a 24-year old high school drop out, told the WSJ: “I thought insurance was supposed to be some kind of great thing, but it hasn't changed” a thing.

An article in the Washington Post today reported on the growing shortage of physicians on a national scale with medical school enrollments declining nearly 20 percent in the past decade, as physicians have seen their incomes drop 7 percent just between 1995 and 2003 due largely to reduced insurance and Medicare/Medicaid reimbursements. They also say government regulations and insurer managed care mandates mean they can no longer practice medicine. Medicare regulations alone fill 130,000 pages, which have made for soaring administrative costs and headaches for doctors and providers. According to reporter Regina Herzlinger:

Increasingly, independent physicians, accountable only to their patients and the Hippocratic oath, have been replaced by salaried doctors who are accountable to the hospitals or insurers that employ them. Salaried physicians are closely policed for productivity, leading to ever-shorter and more numerous appointments per day.

Meanwhile, academic medical journals routinely publish studies...lauding the virtues of single-payer health-care systems, such as those in Canada or Britain, in which the physician is paid only by the government. German physicians unhappy with their salaries and work hours under this kind of system had no recourse against their monopolistic bosses but to go on strike last year.

Or not practice medicine. When it comes to cable or telephone service, most people understand the idea that monopolies and government mandates can be detrimental for consumers — raising costs, eliminating competition and reducing choice, and creating shortages. But that insight vanishes when we believe we might be able get something free.

Of course, free is a myth. While it would once have been unimaginable in the United States, Massachusetts may soon need to take a lesson from Canada and launch a website to help its residents navigate the exorbitant wait times for medical care.

© 2007 Sandy Szwarc