Doctor shortages will limit access

Published 8:53 pm Saturday, January 4, 2014

1. Obama says he’s ready to sign Medicare doctor payment fix

There’s one completely predictable consequence of the Affordable Care Act that no one has an answer for: The looming doctor shortage.

Even in the best-case scenario, in which everyone who is eligible signs up for health care (either through expanded Medicaid or through healthcare.gov), those newly covered Americans could soon learn they don’t have any better access to health care than before. That’s because there aren’t enough doctors to see everyone.

That’s not an unlikely scenario at all. We’ve known for years we’ve had a doctor shortage — and that one big reason cited by doctors themselves is the onerous burdens placed on their profession by the federal government. With the draconian new rules imposed by Obamacare, the vast majority of physicians now say they’ve considered quitting.

“Eighty-three percent of American physicians have considered leaving their practices over President Barack Obama’s health care reform law, according to a survey released by the Doctor Patient Medical Association,” the Daily Caller reported last year. “The DPMA, a non-partisan association of doctors and patients, surveyed a random selection of 699 doctors nationwide. The survey found that the majority have thought about bailing out of their careers over the legislation.”

Even if no doctor quits, the U.S. will face a shortage of at least 90,000 doctors by 2020, the government estimates. Five years after that, the shortage will be 130,000.

“Doctors clearly understand what Washington does not — that a piece of paper that says you are ‘covered’ by insurance or ‘enrolled’ in Medicare or Medicaid does not translate to actual medical care when doctors can’t afford to see patients at the lowball payments, and patients have to jump through government and insurance company bureaucratic hoops,” said Kathryn Serkes, who co-founded the DPMA.

We know what that’s like in Texas, which faced a doctor shortage in the 1980s, when the state found itself losing physicians, largely because of the risk of lawsuits and diminishing returns.

“Doctors were caught between rising medical malpractice insurance costs and lower compensation from insurance-provided benefit contracts and low Medicare/Medicaid reimbursement levels,” said former state Rep. Joseph Nixon. “Combined with increasing hassles and demands to appear in court or in depositions, doctors were choosing to retire or leave Texas. In doctor-per-citizen ratio, Texas ranked 49th out of 50 states.”

But lawsuit reform was a driving force in the general elections of 2002. And when lawmakers gathered with a new Republican majority, lawsuit reform was a top priority — culminating in the 96-page House Bill 4.

At the same time, voters approved a constitutional amendment, Proposition 12, to allow a cap on non-economic damages.

Doctors began coming to Texas by the thousands — in fact, more than 7,000 in the first five years following the passage of Prop. 12.

That’s one step we can take at the federal level.

Another is to allow some health care workers to expand their duties to include tasks usually performed by a physician. Nurse-practitioners, for example, could be allowed to prescribe.

The point is we know the doctor shortage is coming. We’d better get ready for it.