In anticipation of what might be thought of as the official kickoff of ObamaCare on October 1, there are several articles out there with latecoming realizations about the implications of the law. Chad Terhune, writing in the LA Times, observes:
The doctor can’t see you now.
Consumers may hear that a lot more often after getting health insurance under President Obama’s Affordable Care Act.
To hold down premiums, major insurers in California have sharply limited the number of doctors and hospitals available to patients in the state’s new health insurance market opening Oct. 1.
New data reveal the extent of those cuts in California, a crucial test bed for the federal healthcare law.
These diminished medical networks are fueling growing concerns that many patients will still struggle to get care despite the nation’s biggest healthcare expansion in half a century.
Consumers could see long wait times, a scarcity of specialists and loss of a longtime doctor.
“These narrow networks won’t work because they cut off access for patients,” said Dr. Richard Baker, executive director of the Urban Health Institute at Charles Drew University of Medicine and Science in Los Angeles. “We don’t want this to become a roadblock.”
Read the whole thing for the quantitative rather than just the qualitative implications. The editors of the Las Vegas Review-Journal are concerned about the same thing:
As reported by the Review-Journalâ€™s Jennifer Robison on Sept. 12, Nevadaâ€™s insurers are expected to control the costs of dozens of coverage mandates by slashing the number of doctors and hospitals they contract with, creating what local employee benefits consultants call â€œskinny networks.â€
If you like your doctor, and your doctor isnâ€™t in your new skinny network, then guess what? You will not be able keep your doctor. Period.
Ms. Robison noted that itâ€™s still not clear how skinny those networks will get, because plan designs wonâ€™t be available until Oct. 1, when the Silver State Health Insurance Exchange starts selling policies. Thatâ€™s just 12 days away. And Nevada isnâ€™t alone.
I don’t think they’ve realized the full set of implications. Assuming that the plan is successful, access to healthcare will increase. That, after all, is the purpose of ObamaCare. Physicians don’t have a lot of slack capacity. If anything, they’re overworked. If you increase access without an increase in capacity, it will result in price increases or some other form of rationing. It may also, as suggested in the linked article, actually reduce the supply of physicians, a perverse result if there ever was one. Crank in the “skinny networks” and you have the makings of a real crisis.
That’s been my concern about healthcare reform since it was being so hotly debated back in 2009. There’s an argument that the greatest problem in our healthcare system is excess demand but I think it’s inadequate supply and, sadly, healthcare reform as it was enacted into law did nothing whatever about supply. Except, possibly, decreasing it as the preceeding articles suggest.
Well, we’ve got a real-life experiment to test the hypothesis. Life in the Petri dish is fun, isn’t it?