News coming out of the Massachusetts experiment with “socialized medicine lite” – the combination of insurance coverage that is free, subsidized, or mandatory to make it near universal – continues to be distressing for reasons other than the predictable, ever-escalating cost to the state.
First were the reports from across the state of primary care physician shortages. According to a physician workforce study conducted by the Massachusetts Medical Society, half of the internists in Massachusetts stopped accepting new patients, as did 95 percent of general practice physicians in Boston’s top three teaching hospitals.
Waiting times for appointments, for those fortunate enough to get one at all, increased by more than one-third. Need to schedule a physical? How about this time next year?
The latest development is an astounding change in the way patients and doctors have interacted for generations. “Shared medical appointments” are the new wave in Massachusetts physician practices due to the shortages.
Eight or nine patients with the same general complaint are scheduled at the same time and ushered into a room to have their examinations – together. The doctor examines each one and then discusses with them as a group how to manage their health issue. Other, more personal issues can be discussed with the group, or perhaps with the doctor alone afterwards.
This underscores that having insurance means nothing without access to a provider.
Despite significant increases in the number of health professionals since the passage of medical liability reform in 2003, Texas remains in a shortage. The guideline for an appropriate ratio of health professional to general population is considered to be 1-to-1,500. The guideline for being declared a health profession shortage area is when it reaches 1-to-3,500. Texas’ current ratio is 1-to-4,016.
Even worse, demographic trends reveal an undeniable confluence of important factors – a huge increase in the elderly population, a growing general population, and a dramatic decrease in medical students selecting family practice and internal medicine.
In a normal marketplace, supply and demand would dictate a higher price for the item or service in short supply; that would draw more resources to meet the increased demand. Instead of paying more for what is needed, primary care physicians’ average annual earnings have been artificially driven down to about half that of specialty doctors.
The average student loan debt coming out of medical school is about $150,000. Two more years in a specialty residency would increase the doctor’s annual income by roughly that amount. Little wonder that medical students are choosing the specialty route.
Government programs and managed care insurers are much to blame for the market distortions. Reimbursement levels have declined while administrative demands have increased. The result is that family practice physicians spend less time seeing patients and more time filling out the paperwork plus paying a third party to file it all – a recipe for a dissatisfied doctor. Perhaps that is why nearly half of the physicians nationwide plan to reduce the number of patients they see or quit the practice of medicine altogether in the next three years, which will amplify the physician shortage.
Many are looking again to the government for solutions. The late physicist Albert Einstein defined insanity as doing the same thing over and over and expecting a different result. Heavy government involvement in the field of medicine always results in fewer providers and lower quality of care. Government health care programs are responsible for the high cost and malfunctioning marketplace we have today.
Every proposal should be judged by one question: Will this measure result in more government control or more personal control? If the answer is the former, as with the proposed expansion of the Children’s Health Insurance Program soon to come before the new Congress, then the measure is a problem, not a solution. Regardless of where the income limit is set, the people just above the limit will find insurance unaffordable while those within the program find health care inaccessible.
Looking to government to solve our health care problems is, well, insanity. And Massachusetts’ “socialized medicine lite” proves it.
The Honorable Arlene Wohlgemuth is a Visiting Research Fellow at the Texas Public Policy Foundation, a non-profit, free-market research institute based in Austin. She served six terms as a member of the Texas House of Representatives, specializing in health and human services issues.