Free Markets, Free People
One of the things many who have studied the problem of health care in the US have known for quite some time is that there is and will be a shortage of primary care doctors in the US. These doctors are the gatekeepers in the system in which health insurance providers require primary care doctors manage the health care of patients and be the ones to authorize referrals to specialists.
The shortage of these doctors isn’t news nor is it something new. Only 30% of practicing doctors are in primary care. 65 million Americans live in areas where a shortage of primary care doctors exists. And ObamaCare’s extension of insurance benefits will add another 30 million to the roles who will have to seek a primary care physician.
So, how does the administration plan to address this known problem? With incentives for such doctors to take Medicare and Medicaid patients whose reimbursement for services is known to be lower than that of private insurance? Announce a plan to incentivize incoming medical school students to become primary care doctors?
Nope. It’s to snoop on existing primary care doctors by enlisting “mystery shoppers” who will falsely identify themselves as potential patients with various types of insurance (Medicare, Medicaid and private) to determine whether the physicians called discriminate among who they’ll accept.
Alarmed by a shortage of primary care doctors, Obama administration officials are recruiting a team of “mystery shoppers” to pose as patients, call doctors’ offices and request appointments to see how difficult it is for people to get care when they need it.
The administration says the survey will address a “critical public policy problem”: the increasing shortage of primary care doctors, including specialists in internal medicine and family practice. It will also try to discover whether doctors are accepting patients with private insurance while turning away those in government health programs that pay lower reimbursement rates.
As you might imagine, doctors who’ve learned about this upcoming attempt are not at all happy with it:
Dr. George J. Petruncio, a family doctor in Turnersville, N.J., said: “This is not a way to build trust in government. Why should I trust someone who does not correctly identify himself?”
Dr. Stephen C. Albrecht, a family doctor in Olympia, Wash., said: “If federal officials are worried about access to care, they could help us. They don’t have to spy on us.”
Dr. Robert L. Hogue, a family physician in Brownwood, Tex., asked: “Is this a good use of tax money? Probably not. Everybody with a brain knows we do not have enough doctors.”
In response the administration says:
In response to the drumbeat of criticism, a federal health official said doctors need not worry because the data would be kept confidential. “Reports will present aggregate data, and individuals will not be identified,” said the official, who requested anonymity to discuss the plan before its final approval by the White House.
Christian J. Stenrud, a Health and Human Services spokesman, said: “Access to primary care is a priority for the administration. This study is an effort to better understand the problem and make sure we are doing everything we can to support primary care physicians, especially in communities where the need is greatest.”
Now, being the skeptic I am and having watched government operate for decades, I tend to see other possibilities in this sort of an effort. Remember, ObamaCare was passed by Democrats, most of whom see health care as a “right”. Thus, they feel they have the right to mandate that a) everyone have insurance and b) that everyone with insurance have access to a physician. They got the “a” done in ObamaCare. Left undone is the mandate that all insured have access to a doctor – without exception. That mandate would be perfectly in-line with their belief that they can demand the skills, assets and time of one to serve the pseudo-right of another.
Why else would this “stealth survey” involving people falsely identifying themselves to doctors to determine whether they discriminate against lower paying insurance programs be planned? The doctor shortage is known. The administration claims that ObamaCare “includes several provisions intended to increase the supply of primary care doctors” and that this survey is intended to “evaluate the effectiveness of those policies. “ Really? Considering that the law has been in effect only a short time and is not fully in effect, one might find it a bit hard to believe that bit of spin.
Instead it seems much more likely that this is a prelude to something else. This is information gathering to prove something – i.e. doctors are discriminating. And we all know that in our new, brave world, “discrimination” is a mortal political sin. Does anyone not believe the outcome of such a survey might be used to attempt to pass an anti-discrimination law or a law which requires primary care physicians to accept anyone with insurance who applies regardless of coverage?
Yeah, me too.
One of the more persistent myths about the push for universal health care is its provision will solve our medical care problems and improve our overall health. Well there’s one problem with that – medical care depends on the availability of medical care providers, and we have a shortage of those. So while everyone may have insurance, insurance doesn’t guarantee access.
Massachusetts offers a snapshot of how giving more people insurance naturally drives demand. The Massachusetts Medical Society last fall reported just over half of internists and 40 percent of family and general practitioners weren’t accepting new patients, an increase in recent years as the state implemented nearly universal coverage.
The entire push of the new law is to shift the country from seeking care when they’re sick to seeking preventive care to help prevent sickness. That means a shift from primary care physicians who are essentially gate-keepers (to specialists) to primary care physicians as, well, the primary care source for the patient. One problem – primary care physicians only make up 30% of the physician population. Couple the shift in emphasis with the addition of 30 million newly insured and you can do the numbers yourself.
So how is this going to be reversed? Well here’s the plan:
Yet recently published reports predict a shortfall of roughly 40,000 primary care doctors over the next decade, a field losing out to the better pay, better hours and higher profile of many other specialties. Provisions in the new law aim to start reversing that tide, from bonus payments for certain physicians to expanded community health centers that will pick up some of the slack.
Or, in other words, government plans on incentivizing primary care with “bonuses” and essentially deincentivizing specialists. The obvious hope is some specialists will go back to school and become primary care physicians. But there’s a culture at work within the physician community which is going to resist that. The other hope is more will choose primary care in medical school. Again, that cultural hierarchy will, at least initially, resist that. The hoped for result is a flock of primary care physicians and far fewer specialists. Market forces? Ha! And ignore those doctors who aren’t taking any new patients or are dropping out of the insurance game altogether to charge annual fees for unlimited visits and consultation.
Anyway, the grand plan, once this shift begins taking place, is to take a team approach to your care in something you will lovingly call your “medical home”:
Instead of the traditional 10-minutes-with-the-doc-style office, a “medical home” would enhance access with a doctor-led team of nurses, physician assistants and disease educators working together; these teams could see more people while giving extra attention to those who need it most.
I don’t know about you, but that’s pretty much how my care works now. I see a PA. She refers me to my primary care physician only if there’s something out of the ordinary for which his expertise is needed. Otherwise it is the rest of the team that takes care of me. The only thing this law changes is the number of people out there seeking this sort of care as far as I can tell – and oh, yes – this system has been in place with my physician for years. So somehow I’m missing how what they’ve been doing for years has been inadequate, but now that government thinks it is a good idea and it will suddenly take care of all our problems concerning access, and improved care, etc.
Your “medical home” will also include the following. Now I’m a bit of a student of human nature – but this too seems to be a bit of a fantasy:
Rolling out next is a custom Web-based service named My Preventive Care that lets the practice’s patients link to their electronic medical record, answer some lifestyle and risk questions, and receive an individually tailored list of wellness steps to consider.
Say Don’s cholesterol test, scheduled after his yearly checkup, came back borderline high. That new lab result will show up, with discussion of diet, exercise and medication options to lower it in light of his other risk factors. He might try some on his own, or call up the doctor — who also gets an electronic copy — for a more in-depth discussion.
Tell me – if Don is concerned about such things and willing to search out and consider options to help his condition, don’t you reckon he might already be on WebMD or a similar site right now doing that? And if Don isn’t likely to do such a thing, is this “custom Web-based service” likely to entice him to log on and do so?
That’s the whole fallacy behind preventive care – it assumes that if it is offered it will be sought out and its recommendations followed – without exception. The assumption is that Don, who has never followed the advice of his doctor about his cholesterol will suddenly do so because we’ve shifted the emphasis of his care to prevention and provided him access to information.
And, with the shortage of doctors and increased demands on their time, how likely is Don to really get that “in-depth discussion” he wants from his doctor? Yeah, not very. So how likely is Don to get frustrated with all of this and revert to his old and more comfortable (albeit less healthy) lifestyle? Meanwhile, doc has lots of new patients admitted into the “home” that his “team” is trying to deal with preventively or, doc is simply not taking any new patients because he or she can’t spend the time necessary with those already in the practice.
The point? As with most things centrally planned, it sounds good on paper. But such plans tend to discount human nature. They also tend to be overly optimistic. And lastly, they usually underestimate or ignore the true numbers involved in favor of some fantasy result where everything works as planned despite those numbers. That’s what we see here.