As more people read and analyze the health care reform act, more and more potential issues are being raised. Funding for abortions, procedures approved based on the patient’s economic value and elimination of private health insurance are just a few of the issues raised. Any one of these by themselves should be enough to cause people to say “whoa!” In total they should be enough to have thinking folks recognize that this bill’s approach to health care reform should be thrown out completely. As important as any of these, and many others that I haven’t listed are, there is one issue that has received very little attention but if understood completely, should bring this house of cards called reform, crashing down.
Three years ago Massachusetts implemented its version of health care reform. The program in Massachusetts is the closest real life experiment of what is being proposed as the national version of health care reform. The plan requires nearly everyone to have health insurance. There are subsidies for those who can’t afford the insurance, penalties for companies that don’t provide insurance and the plan provides insurance to illegal aliens, all similar to the proposed national plan.
Massachusetts is a blessed state when it comes to health care professionals. In a recent survey by the Kaiser Family Foundation, Massachusetts has the highest rate of non federal physicians per thousand of population. In fact, at 5.3 physicians per 1,000 population, Massachusetts’ rate is 60% higher than the national average of 3.3 physicians per 1,000 population.
One would think that with such a high physician to population rate, access to health care would be easy in Massachusetts. One would think that with a rate significantly higher than the rest of the nation you should be able to pick up the phone and get a medical appointment with little if any delay. You might think that but if you do, you would be wrong.
A recent survey by Merritt, Hawkins & Associates looked at the average length of time it takes to get an appointment with various physicians. The study looked at waiting times for several specialties as well as family practice. It looked at 15 major cities including Boston. The study found that of the cities survey, Boston had the longest wait times for getting appointments with physicians. Not only that, but Boston’s average wait time of 49.6 days was more than twice as long as the national average of 20.5 days. If that doesn’t concern you, the average wait time for a family practice appointment for a routine physical was found to be 63 days in Boston. If you’re still not concerned, the study found that with the exception of cardiology, the waiting times for all specialties that were surveyed in both 2004 and 2009 had increased, in some cases substantially.
What’s the point? Massachusetts has always had a high ratio of physicians to patients. Relative to national statistics, Massachusetts traditionally had a small number of uninsured individuals. Prior to the implementation of their health care plan, Massachusetts was estimated to have 10% or fewer of its population uninsured compared to 15% – 16% nationally. If Massachusetts with relatively fewer new insureds and significantly high physician to patient ratios can’t manage to manage access times after the implementation of unrestricted health care, what does that portend for health care consumers if a national plan is implemented?
According to Kaiser Family Foundation there are 46 million people without insurance. You can see the breakdown by state here. Let’s assume that we now insure every person in the country with a national plan. Let’s assume that to maintain existing wait times we will need to maintain the average ratio of physicians to population. As a proxy, let’s assume that for each 1,000 additional insured we will need to increase physicians by the current rate per 1,000 (this is actually a bit low if you work through the math because the divider should actually be the insured people versus total population but we’ll allow for a bit of breakage.) If we extrapolate that number, how many additional physicians will we need? The following chart shows by state, how many additional physicians we will need to maintain access times:
To maintain the same level of physicians to insured, the country would need to have nearly 144K additional physicians on the day that the health reform act became operational. 144K is an increase of 15% in total physicians. According to the Department of Health and human services, at the projected level of medical school graduations the country won’t increase the number of physicians by 144K until well after 2020. Even if we increase medical school graduation rates by 20% we won’t achieve the 144K increase until after 2020.
More frightening than the total increase in physicians required is the instantaneous shortfall that several states will have if the national health plan is implemented. Take note of Texas which will need a 24% increase in physicians to stay even, New Mexico will need 22%, Mississippi and Florida will need 20% and Arizona will need a 19% increase.
In free market economics the result of dramatically increasing the demand of a product needs to be met with an equivalent increase in production or an increase in prices that will remove some demand for the product. In the case of national health care, demand will increase, prices will not be allowed to increase so how will this work? If production can’t be increased or prices adjusted, the only other way to balance the equation is to regulate the demand, this is called rationing.
Folks, the math on the number of physicians doesn’t work. There is no way to dramatically increase the number of insured into the system, restrict or reduce pricing and not have rationing. Well, there may be one way to do it. Grab your magic wand, waive it and say “Poof, you’re a physician!”
