The PPACA addresses only one of the healthcare shoes. It’s concerned with how healthcare is paid for, increasing access to healthcare insurance. Actually, that’s the easy part. The hard part is increasing access to care. The PPACA did nothing to change how healthcare is provided and that second shoe will drop soon. The Boston Globe explains the implications:
Across Massachusetts, about half of primary care doctors aren’t taking new patients, according to the Massachusetts Medical Society’s 2013 Patient Access to Care Study. The rate for internal medicine specialists, or internists, who often also serve as primary care doctors, is 55 percent. If you’ve found a new doctor and want to schedule a routine visit, be prepared to wait. It takes an average of 39 days for new patients to get an appointment with a family physician and 50 days to see an internist. That’s better than last year, when the average wait was a whopping 45 days, but up from 29 days in 2010.
The wait could get longer. The Association of American Medical Colleges projects that nationwide 13,700 more doctors of all types were needed than were available in 2010, and that the gap will hit 130,600 by 2025, with about half of the shortfall in primary care. Are doctors becoming two-headed calves? No, but they are getting scarcer, for lots of reasons.
Among the reasons are more old people, Baby Boomer docs retiring, the increasing tendency towards specialization, and greater demand induced by the PPACA.
If you think the battle over the PPACA has been hard-fought, you ain’t seen nothing yet. We need to make basic changes in medical education, licensing, and how medicine is actually practiced to increase the availability of primary care.
So, things aren’t getting worse, they got worse, and now they’re getting better?
I’ll bet those averages don’t hold across all income brackets. For example, I doubt people on Beacon Hill in Boston are having a hard time finding a doctor. Poor areas have always been desperately underserved, so there was no pool of doctors lying around in the various ghettoes or working poor neighborhoods where no one had insurance anyway. Now more of those people are getting care (a good thing) and can pay for it (another good thing) and so there’s a localized shortage which has started to self-correct as doctors see more gold in them thar section 8 houses. Plausible?
I’m not going to try to change your worldview, Michael, because its a fools errand. But some observations.
1. Gold in Section 8?? I recently read a piece citing the Cleveland Clinic. Reimbursement rates are going to be arbitrarily cut under govt control. (Private ins vs public reimbursement rates) Costs structures will have to be cut by a third. Gold?? Hardly. Supply will be constrained which means…….
2. For every poor person you cite who is now getting care, a dozen middle incomers will have restricted care. There is no free lunch. But yes, the rich will be fine. But when was that not ever so? Is this a good result, and warrants a near complete takeover of health care by the DMV?? There must be a better way.
3. As for waits………..you just wait. Ask Canadians.
I watch with a wry smile as I see people complaining over increased deductibles. I think that’s good. I note the free rider problem. Its being handled with a meat ax, but its a real issue. And portability.
But these narrow issues are being addressed by the mother of all government structure nightmares………..and we are just getting started. I also note the preferential treatment of the politically favored: unions, Big Business, government workers………..next thing you know just about every left leaning or politically donating organization will be carved out or subsidized……….like everything else the government touches. Max Baucus had it right: This is going to be a train wreck, and the wheels are already off the tracks even as the train is leaving the station.
I live in IL, where mob, er, Democrat rule is the norm. We are #50 in the country in state finances.
Who’d a thunk it? I guess we need a Cal-Tech or fewer ore boats or a sun shining dome or sumthin’.
Well, Drew, I can’t help it if you live in Upper Mississippi. Here in California, where our last few Republicans were finally driven into the desert where they can’t bother anyone, things are looking pretty good. RE prices up, employment sucks but UE is down a third from the worst of it, Covered California wants to save me a bunch of money and our budget is balanced.
Also the sun is shining, the bay sparkles, and we’re getting a new In-N-Out up next to Costco. Maybe you should give up on Illinois and move to America.
All of which still leaves you explaining why the wait times in MA went down after going up. Because as you know, that’s not what you’re predicting. Kind of like the deficit which was going to go up and up and then, oopsie, went down and down.
Here from Science Daily: http://www.sciencedaily.com/releases/2013/05/130516161651.htm
Of course that’s just actual data based on reality. No doubt your predictions (You’re what, 0 for 5?) will come true this time. Simple law of averages dictates you have to eventually be right about something. Right?
One response to increased wait times is less usage. During the wait period, many minor issues will be healed before treatment. Many people will not schedule an appointment when the wait times are long. The system does self-correct, but not in the way one thinks it would.
Poor people with EBT cards do not attract Target or Costco. They are served by the much vaunted Walmart. When medical corporations move in to serve the poor, I expect to hear the cries about the employee’s pay.
The medical service for the poor will be the same or worse. Why mine the Section 8 houses? The increased demand from the middle-income houses is a lot easier to mine.
At the VA, 45 days is nothing. They can only schedule 60 days out. You get put onto a list, and when an appointment is available, you are scheduled. If you cannot make the appointment, you get put back into the queue.
Getting to see a specialist takes longer, and the doctors are discouraged from sending anybody to them. Your primary care physician is not trusted to make the decision. He/she must submit you to a pre-screening test, and you must pass the pre-screening test to see a specialist.
Welcome to my world.
Tasty:
And yet, as quoted above:
They went looking for the problems. They weren’t there.
So Republicans are in a race-fueled panic over a program which in its Romney-fied test case did not cause the world to end. And to just summarize the new ABC poll, “America to GOP: we freaking hate you.”
Good times.
“Reimbursement rates are going to be arbitrarily cut under govt control. (Private ins vs public reimbursement rates).”
Not really arbitrarily, unless one believes that legislation is arbitrary. The fact is that the ACA cut reimbursement rates to hospitals for the care of the uninsured. (Per law, any hospital that accepts Medicare must treat the uninsured.) Here’s the rundown:
But…
Hospitals in those states that do not accept the Medicaid expansion will take a big hit.
Ah, sorry. Left out the source: The super wonky reason states may join the Medicaid expansion.
As I said, Michael, you are the King of Selective “Facts.” I’m tired of trying to change that. IL is the poster child for Democrat control and policies, with predictable results. I recently commented about the vaunted California economy in San Jose………..which is going broke, not to mention in the heart of Silicon Valley. Michigan is also the same, and NJ, and NY and……….well, never mind.
You say you are feeling positively European. Well, my condolences on your bankruptcy. Its not working, Michael. It just isn’t. Obama has been a boon to the super-rich, including you, and a disaster to the poor. Its fun to make fun of middle America. I lived in NY metro. They think the earth ends at the Hudson. I get it. (And by the way, you don’t exist or matter to a NYorker. Don’t kid yourself. In their view the only other place that cretins don’t live is Washington DC.) But the haughty flushing of middle America widget makers who drive Chevy vans or trucks down the toilet for the benefit of NY investment bankers and California film makers is a really cruel worldview.
The most fascinating graphic ever is that of the voting by county for this country. Cities? Full of elitists, or, conversely, those on the dole, but significant in number? Democrat. 90% of the balance, Republican. And we wonder why things are polarized……
@michael reynolds
From your link:
These results are about in-patient hospital usage not healthcare usage. The ER usage should have declined, but there is no mention of this. Unless people had increased in-patient ailments, the usage should change little.
I am highly suspicious of this article. Without the actual study or a synopsis, I have no idea if they cherry-picked or not.
If I am correct, usage will not increase greatly, or the increases will quickly return to “normal”. I suspect that there is a wait time limit for most people, and it is more than likely much shorter than at the VA. Vets are used to waiting. Vets are on the leading of getting f*cked.
As to the Republicans, I cannot care any less. They can go the way of the Whigs, and they can take the Democrats with them.
When you get injured from “patting yourself on the back”, I have no doubt you will get outstanding healthcare, and the poor will still get the care you deem unacceptable.
The poor are the “playthings” of liberals. Why should healthcare be any different?
In Massachusetts since RomneyCare was enacted they’ve experienced a very slight decrease in emergency room visits and practically no change in overall hospital visits. When prices are rising at a many times multiple of the non-healthcare rate of inflation, that means essentially no cost savings due to fewer emergency room visits. They’ve just raised the prices to make up for the small decrease.
I went and bought a new high end sports car. It didn’t start. The salesman said “we’ve had some glitches.” So I took it up the……..
I went and bought a new computer. It didn’t boot. The salesman said “we’ve had some glitches.” So I took it up the……..
I went and bought a new stereo component. It didn’t play. The salesman said “we’ve had some glitches.” So I took it up the……..
I went to the DMV to get a new license. I didn’t have the right forms. I didn’t know. The DMV person said “we’ve had some glitches.” So I took it up the……..
I went to a restaurant and got food poisoning. The owner said, “we’ve had some glitches.” So I said “no problem” and took it up………….right.
I bought a new driver. First swing it broke. The salesman said “we’ve had some glitches.” ……………..
You want some entertainment? Go to econbrowser. Slobbering Obama apologist Menzie Chin who has been telling us that this recession was just garden variety………since 2010, is now worried about shrimp inspection and government stats. You know, those stats that are always revised downward “unexpectedly?”
But concern about “glitches?” Crickets……….
…and while the US is racing towards becoming more European, in it’s nanny state impersonations, France’s recent polling indicates the right is coming back becoming the new favorite to win future elections – same switch recently occurred in Australia too.
Jan:
You do understand that “the right” in Europe still favors universal health care, right? Also thinks you people are freaking crazy for shutting down the government and threatening default.
Drew:
There’s you with your rather weak record of prediction.
And then there’s California Obamacare which wants to save me thousands of dollars a year.
Who do you think I’m going to believe?
The US has never done well on wait times. We are in the middle or lower middle of the pack. People like to cite Canada, but forget that the leaders in best wait times have much more socialized medicine than we have, places like the UK, New Zealand and Switzerland.
We have always lagged in numbers of primary care docs. I suspect this is primarily because we have larger disparity in pay between PCPs and specialists than in most other countries. That, plus medical education is more heavily subsidized in most other countries. The kids I recruit now are terrified about the amount of school debt they are carrying.
Data on these two issues at link.
http://theincidentaleconomist.com/wordpress/enough-with-the-wait-times-already/
Steve
And I suspect that’s primarily because of the way the relative value of what specialists do is established relative to what PCPs do. If people aren’t familiar with it, it’s not done by any sort of market. Essentially, it’s done by committee. And the objective appears to be to push more physicians into specialties.
As to the subsidization of healthcare being more elsewhere, that’s only true as a percentage of cost. Mostly what that says is that healthcare education is absurdly high in the U. S. relative to what it is in other countries (largely because salaries here are higher).
Your self serving nature is duly noted, you “oh-so-caring of the little man” son of a bitch, Michael.
steve – I just don’t understand your frame of reference. Dave either, as he said some 4-5 years ago that he couldn’t get an appointment with a primary. I can get one, and lord knows I’ve needed it the last 12 months, in about 7-10 days. DuPage Medical Group. Naperville, IL. Great docs.
And when I needed a high powered specialist I got an appointment with University of Chicago medicine in about 18 days. What the hell is going on elsewhere?? I have no special clout.
“You do understand that “the right†in Europe still favors universal health care, right? Also thinks you people are freaking crazy for shutting down the government and threatening default.”
Michael,
My reference was general, not specifically aimed at health care, but at the overreach of government, especially in taxation.
As for what Europeans think of us…how can you be so sure that all their disgust is aimed at conservatives? Obama and the dems aren’t looking too pretty either, at the moment. In fact, Obama is actually rallying and consolidating animus against the hysterical stranglehold that Reid and the dems seem to think they are entitled to over the economy or whether the US goes into default or not.
Also, IMO, arrogant assumptions, that have no ownership of problems, simply blaming others over and over again, is unattractive, turning people off.
Drew- I am a doctor. My wife used to be one. Wait times for any kind of pediatric specialist in our area are in the months to over a year time frame. If I use the doctor card, it can be reduced by a few months. Out in the hinterlands it is very hit and miss getting seen by specific specialties. PCPs are in short supply here, but you can get seen within a month or two.
Dave- That is how Medicare sets rates. The private insurers do not have to follow those rules. They often do, but not always.
jan-Come back to earth. Congress voted for spending and revenue levels. They now refuse to fund what they voted for. This was not the idea of any Dem. The Rs want the law changed, but offer nothing in return. Nothing, unless you count the economy which they are holding hostage. Read back a few months ago. You will find zero left wing sites saying let’s shutdown the govt so we can get something. You will find lots of right wing sites advocating that the govt be shutdown if their demands are not met. Who is now saying nothing really bad would happen if we did default? No one on the left.
The debt limit is a dumb idea. No one else (maybe the Netherlands?) has one. It s used to give politicians a chance to grandstand. It is not something that should be used with the intent of really defaulting.
Steve
Denmark has one. Actually, all of the euozone countries do since under the Stability and Growth Pact they’re limited to deficits of 3% and a maximum of 60% debt to GDP. Nobody enforces it so it’s just wishful thinking.
I agree that the mechanism of the debt ceiling is unworkable. The Congress should be required to declare for each appropriation passed where the money will come from. Rather than just the general fund, that is. I think that spending enacted in excess of the ceiling should be declared null and void. Sort of the opposite of the present situation.
However, that’s a sort of “Can God make a stone He’s unable to lift?” sort of philosophical question. Can Congress pass a law they won’t approve borrowing to pay for?
jan-Come back to earth. Congress voted for spending and revenue levels. They now refuse to fund what they voted for. This was not the idea of any Dem. The Rs want the law changed, but offer nothing in return. Nothing, unless you count the economy which they are holding hostage. Read back a few months ago. You will find zero left wing sites saying let’s shutdown the govt so we can get something.
The unyielding voices holding onto this lengthy, unaltered government shutdown, and now threatening default are the democrats. They have become nothing more than squeaky wheels, in this political theatre, harping on getting what they want unconditionally, heaping great rancor on their opponents, in the process.
Steve, even though you think I’m floating above the earth, I personally think your interpretation of the House’s fiscal actions and reactions are simplistic democratic talking points, and very much at odds with the true picture — that being Obama’s Administration stonewalling serious budgetary attempts by republicans to put safeguards into our deficit spending habits. The CR’s that have been passed, have not solved these problems, but only deferred them to future times. Now, the republicans are calling the democrat’s hand, wanting them to consider legitimate, long term legislation that will address structural problems, rather than arguing over serial and meaningless extensions of credit.
Furthermore, legislation has been continuously submitted from the House to the Senate, by means of appropriation bills, that have been shoved to the side in the Senate. Even in this latest hassle, Reid stubbornly refuses to even consider piecemeal ‘fixes,’ serving to fund and open up portions of the 17% of government that is closed down, amidst ongoing Congressional wrangling. IMO, the party playing political hard ball are the dems, while the House is standing firm in trying to do it’s job in the face of hostile partners, on the other side of the aisle.
According to a commentary written by the Congressional Research Servicethe debt limit functions as an important leveraging tool for Congress to moderate spending — something the dems and you, though, describe as being a hostage situation when the R’s don’t docilely cave to unconditional demands offering no give or negotiation options. However, according to the Congressional verbiage, the Congress is fulfilling a vital role of oppositional checks and balances regarding excessive spending without first reducing expenditures elsewhere:
Trying to repeal the ACA has been an ongoing fiscal concern, as this legislation has had an overall negative effect on the economy (jobs and business uneasiness) and a doubling of costs above the original CBO projections. But, that was quickly dropped in this Fall ’13 debate, replaced by reasonable changes that have already been advanced to others by the Obama Administration. There is even a plan in the mill to include Unions, by legally inoculating them from the full brunt of the law, while families and individuals remain curiously excluded from said beneficial changes. Nonetheless, whatever happens, the challenges of spending more than we are pulling in are real and growing problems.
Sorry, Dave, about the mistake made in closing the above link, putting everything following it in italics.
Thanks, Dave.