Published on TheHill.com November 17, 2009
Joseph Stubbs, president of the American College of Physicians – the second-largest doctors’ group in the country – confirms that “the supply of doctors just won’t be there” for the 30 million new patients President Barack Obama wants to cover. Noting that the doctor shortage is “already a catastrophic crisis”. Stubbs noted that underserved areas in the U.S. currently need almost 17,000 new primary care physicians even before Obama’s proposals are enacted.
In the meantime, according to Bloomberg News, a 2009 survey by Merritt Hawkins & Associates, a recruiting and research firm in Irving, Texas, found that “the average waiting time to see a family-medicine doctor in Boston… is 63 days, the most among the 15 cities” surveyed. By comparison, in Miami, it was only seven days. The study noted that Boston’s longer wait was “driven in part by the healthcare reform initiative” passed in 2006 in Massachusetts, upon which the Obama program is modeled. Bloomberg reported that “as many as half of doctors in the state have closed their practices to new patients, forcing many of the newly insured to turn to emergency rooms for care”.
Alan Goroll, a professor at Harvard Medical School, said that “the primary lesson of healthcare reform in Massachusetts is that you can’t increase the number of insured unless you have a strong primary-care base in place to receive them. Without that foundation… Massachusetts has ended up with higher costs and people going to emergency rooms when they can’t find a doctor”.
Additionally, a study by the Centers for Medicare and Medicaid Services, part of the federal government’s Health and Human Services Department, found that expanding insurance coverage to an estimated 32 million people who now lack it would create a demand for medical services that “could be difficult to meet initially… and could lead to price increases, cost-shifting and/or changes in providers’ willingness to treat patients with low-reimbursement health coverage”.
Indeed, the report found that the Medicare cuts contained in the House-passed bill are likely to “prove so costly to hospitals and nursing homes that they could stop taking Medicare altogether”.
The dynamic of the healthcare debate is decidedly turning against the administration. As details of the doctor shortage, Medicare cuts, tax increases, penalties for no insurance, shallow subsidies and high costs for the uninsured all leak out, more and more Americans are developing qualms about the bill.
But within Congress, the momentum is the other way as the bill hurtles toward December passage in the Senate.
But then it will hit a wall as the chambers try to reconcile their different versions so as to satisfy the liberal House and Obama’s base on the one hand and the most conservative among the 60 Democratic senators on the other. This debate will focus on such a broad range of issues and will be so contentious that it is going to take a long time to resolve.
Meanwhile, popular angst with the bill will continue to build and Election Day will approach. More and more members will be anxious about supporting the bill and both left and right will dig in their heels and resist compromise.
The healthcare bill may pass both houses, but may not be able to be enacted into law. The tide of public opinion cannot be resisted.