Talking heads, politicians, and prognosticators have beaten the war drums ad-nauseum against the more onerous and visible aspects of the Affordable Care Act (ACA), aka “Obamacare”, aka “beta test for single payer.” Congressional exemptions. Website woes. Hundreds of thousands losing current coverage despite pointed assurances to the contrary. We’ve heard them. So, accordingly, I won’t here belabor what others are ably shedding light on (or spinning half to death, depending who one listens to).
Consider, rather, an impending issue percolating on the back burner of American health care; a problem that inexplicably never entered into debate during Congressional consideration of the ACA in 2010, and is only loosely alluded to presently: the coming physician shortage.
The realities of this shortage are, at once, both baffling and menacing with respect to the justifications given for passing sweeping reform. Baffling in that the shortage, particularly among primary care doctors, was anticipated pre-ACA and, common sense dictates, would (or should) have figured into political and practical considerations; menacing because any significant shortfall of doctors nationwide severely undermines the point of reform in the first place: provide more, and better, coverage to the public. Admittedly, asking a short-sighted Congress to entertain long-term consequences hovers somewhere between patent naivete and abject lunacy, but adding millions who need care to a system that, in coming years, won’t be able to provide care, should strike anyone as an oversight. Of the colossal variety.
A quick look at the numbers: By the year 2020, the American Association of Medical Colleges, who oversees medical schools in the U.S. and Canada, predicts a physician shortage of 90,000 nationwide, evenly split between the specialties and general care. Just five years later, the tale becomes 130,000. If ACA supporters were to achieve their dubious, but professed, enrollment goals, between 30 and 47 million new patients will be hitting the system over the same period. The results are, necessarily, a case study in supply and demand with a dash of causality. Patient demand (way) up, doctor supply down. Effect: quality down, wait times up. The arithmetic is simple, inescapable, and stark. Our system cannot handle such an influx of patients while losing a sizable portion of doctors, and expect to dispense timely and quality health care. As Obama would say, period.
“Well, that’s why we need to have the universal systems like Canada or the U.K.,” say our friends on the Left. “Their citizens get free health care and it totally works better over there, man.” Before we polish our maple leaf lapel pins or genuflect to Her Royal Highness, the oft-unreported fact is that these, and other socialized countries, are currently experiencing the problems we face in due order, albeit on a much smaller scale due to population differences.
Britain’s National Health Service has recently reported difficulties in new doctor requirement, all while an estimated one in eight of their 25,000 primary care doctors will enter retirement by the end of 2013. As a result, those remaining or prospective doctors, by some official counts, will be responsible for 9,000 patients each. Wait times and quality, predictably, are affected in the negative. England has almost six times fewer citizens than the U.S. A gambling man would put a C-note on our system experiencing their problems, six fold. If our Revolution was fought to chart a different course from England, why are so adamant about dispensing substandard health care like them? Yes, we can!
In the land of maple syrup and good manners to the North, current wait times are a reasonable and foreboding portent of things to come here. A 2010 study found that a majority (59%) of Canadian patients reported wait times to see a specialist in excess of four weeks, more than double the percentage (20%) in the U.S. Mere inconvenience aside, severe illnesses can grow mighty deep roots if left to fester for weeks waiting to see someone. Doc needs to schedule imaging tests after consulting him? Tough luck. Recent median wait times are five and thirteen weeks for CT and MRI scans, respectively.
Canada faces the same doctor shortages almost every industrialized nation does. Are we prepared to tolerate weeks, then months waiting to diagnose cancer? That’s the fix we find ourselves in. We Americans might do well to adopt the Canucks patented good manners, for if we follow their lead, an ever-increasing number of patients will be hearing news on the theme of “Sorry, there’s not much we can do…”
Hyperbole notwithstanding, the challenges attendant with an unwieldy health care system like ours facing too-few doctors with too-many patients can only be compounded by a top-down reform like the ACA which addresses them not at all. Lack of residency funding, lower medical school enrollment, and aging demographics all work against us. If Nancy Pelosi was right in that “we must pass the bill to find out whats in it,” just how long until the powers that be discover that our problems span deeper than we’ve yet caught on to?