Massachusetts instituted what’s called a universal health care program — about 340,000 of Massachusettsâ€™ estimated 600,000 uninsured have gained coverage, — and now supply is no longer adequate to meet demand. Kevin Sack writes in today’s New York Times —
Once they discover that she is Dr. Kate, the supplicants line up to approach at dinner parties and ballet recitals. Surely, they suggest to Dr. Katherine J. Atkinson, a family physician here, she might find a way to move them up her lengthy waiting list for new patients.
Those fortunate enough to make it soon learn they face another long wait: Dr. Atkinsonâ€™s next opening for a physical is not until early May â€” of 2009.
A 13-month line for a physical? But the wingnuts tell us only Canadians have to wait in line!
In pockets of the United States, rural and urban, a confluence of market and medical forces has been widening the gap between the supply of primary care physicians and the demand for their services. Modest pay, medical school debt, an aging population and the prevalence of chronic disease have each played a role.
This is something I’ve written about before. The fact is that “market forces” have skewed the way health care is delivered in this country away from basic services like preventive care and emergency rooms. That’s because the real money is in providing boutique medical care products and services for those with means to pay for it. About a year ago, I wrote,
Basically, our health care system is good at delivering difficult and expensive stuff but blows at simple, ordinary stuff, like preventive care, compared to other nations. This means we save some lives that might have been lost in Europe, but we also lose lives that would have been saved in Europe.
How did this come to pass? Certainly we Americans value creation and innovation. But itâ€™s also the fact that our private, profit-based health care system is very good at creating new health care products that will make a lot of money. But where thereâ€™s no chance of profit, forget it.
This is what the â€œmagic of the marketplaceâ€ has given us. You know how markets work; where thereâ€™s a demand, someone will hustle to provide a supply, and competition encourages the creation of better products at lower cost. Our system is very good at creating new drugs and new technologies and then marketing them to hospitals, physicians, and even potential patients. And Iâ€™m not saying this is a scam; many of us have benefited from the drugs and gizmos. The problem is that some parts of the health care process just donâ€™t make any money. And where it isnâ€™t profitable, our system is falling apart. …
… Here’s what the “free market” people never seem to wrap their heads around: Unprofitable demands do not generate supply, even when those demands are desperately needed.
Put another way, not everything that’s worth having can generate enough profit to pay for itself. …
… By now “market forces” have so skewed our health care delivery system that, even if we began to allocate our health care dollars according to need rather than profit, it would take years before the neglected parts of our system were built back up to where they should be.
Every now and then there will be a news story about our shameful infant mortality rates or our less-than-stellar life expectancy rates or that emergency rooms are closing or the number of hospital beds per capita is shrinking, and you can count on some wingnut to come out of the woodwork and declare that we are number one at delivering new drugs to colorectal cancer patients that increase their life expectancy by a whole 4.3 months, so take that.
One occasionally finds the claim that the U.S. has too many doctors, rather than a shortage of doctors. The problem is that the “oversupply” seems to fall short in primary care. Kevin Sack of the New York Times explains,
While fewer American-trained doctors are pursuing primary care, they are being replaced in droves by foreign medical school graduates and osteopathic doctors. There also has been rapid growth in the ranks of physician assistants and nurse practitioners.
A. Bruce Steinwald, the accountability officeâ€™s director of health care, concluded there was not a current nationwide shortage. But Mr. Steinwald urged the overhaul of a fee-for-service reimbursement system that he said undervalued primary care while rewarding expensive procedure-based medicine. His report noted that the Medicare reimbursement for a half-hour primary care visit in Boston is $103.42; for a colonoscopy requiring roughly the same time, a gastroenterologist would receive $449.44.
My understanding is that there are adequate numbers of medical students who graduate as general practice doctors, but since they carry an average of $120,000 debt for student loans they can’t afford to go into primary care.
This is unfortunate, because comprehensive health care reform requires better primary care so that health problems are prevented or treated at earlier stages. But in the U.S. “market forces” are better at creating and marketing expensive drugs and gizmos to hospitals to treat seriously ill patents. Ain’t no money to be made in preventive care. Money to be saved, yes, but not to be made. So emergency rooms rot, and people in Massachusetts wait 13 bleeping months for a bleeping checkup.
The situation may worsen as large numbers of general practitioners retire over the next decade. The incoming pool of doctors is predominantly female, and many are balancing child-rearing with part-time work. The supply is further stretched by the emergence of hospitalists â€” primary care physicians who practice solely in hospitals, where they can earn more and work regular hours. President Bush has proposed eliminating $48 million in federal support for primary care training programs. [emphasis added]
Of course he has. You can count on Bush to do exactly the wrong thing.
Anyway, just because real-world experience proves beyond a shadow of a doubt that “market forces” will not provide anything approaching halfway decent health care for all Americans doesn’t mean the wingnuts will lose faith in market forces. There’s no point even arguing with them. And because wingnuts dominate media, few Americans hear all sides of this argument. All they ever hear about are waiting lines in Canada.
Of course, the only reason we haven’t had worse waiting lines here is that so many people have been kicked out of the health care system altogether.
Be sure to read Paul Krugman’s most recent column, “Voodoo Health Economics.” GOP presidential candidate John McCain’s health care plan is, essentially, to allow the “magic of the marketplace” to provide inexpensive health care for everyone. Krugman explains in no uncertain terms why this is nonsense. The Boston Globe has more about McCain’s not-even-half-assed heath care proposals.
I’m not enthusiastic about either Hillary Clinton’s or Barack Obama’s health care proposals. They both fall under the heading of “better than nothing” in my book, McCain’s proposals being “nothing.”
The two Dems may not be beyond hope on health care, however. From an editorial in today’s Toledo Blade:
At one time or another, both Senator Clinton and Senator Obama have said they could support a single-payer national health insurance system, a kind of “Medicare for all,” as a solution to the health care crisis, but they have apparently calculated that it is not politically feasible to advocate it today.
The new survey of the nation’s doctors suggests otherwise.
These findings dovetail with those of an AP/Yahoo public opinion poll last December showing 65 percent of Americans favor a similar approach.
National health insurance is not only necessary, but increasingly popular.
Winston Churchill is remembered to have said of Americans that we always do the right thing, after we have exhausted all the other possibilities.
It is time for our political leaders to stand up for the health of the American people and implement a nonprofit, single-payer national health insurance system.
In part I blame news media for not presenting anything approaching a balanced, fact-based debate on health care. We get only the Right’s POV and more of the Right’s POV. I think if the American people understood the facts, we’d have national health care already.