Human Exceptionalism

Massachusetts Universal Health Care: Back to the Drawing Board?

There is an interesting story in the New York Times today that illustrates the difficulties of reforming our health care system to provide universal access. Massachusetts recently required universal coverage through private or public means. The consequence has been greater health insurance coverage but a terrible dearth of doctors to provide all that extra care. From the story:

Once they discover that she is Dr. Kate, the supplicants line up to approach at dinner parties and ballet recitals. Surely, they suggest to Dr. Katherine J. Atkinson, a family physician here, she might find a way to move them up her lengthy waiting list for new patients.

Those fortunate enough to make it soon learn they face another long wait: Dr. Atkinson’s next opening for a physical is not until early May–of 2009.

Why the bottleneck? The same number of doctors now have to provide care for hundreds of thousands newly covered MA residents:

Now in Massachusetts, in an unintended consequence of universal coverage, the imbalance is being exacerbated by the state’s new law requiring residents to have health insurance.

Since last year, when the landmark law took effect, about 340,000 of Massachusetts’ estimated 600,000 uninsured have gained coverage. Many are now searching for doctors and scheduling appointments for long-deferred care…
Dr. Patricia A. Sereno, state president of the American Academy of Family Physicians, said an influx of the newly insured to her practice in Malden, just north of Boston, had stretched her daily caseload to as many as 22 to 25 patients, from 18 to 20 a year ago. To fit them in, Dr. Sereno limits the number of 45-minute physicals she schedules each day, thereby doubling the wait for an exam to three months.

“It’s a recipe for disaster,” Sereno said. “It’s great that people have access to health care, but now we’ve got to find a way to give them access to preventive services. The point of this legislation was not to get people episodic care.”

Yea, good luck with that. I saw this same phenomenon in Canada a few years ago. There was a front page story in the Globe and Mail worrying that 900,000 residents of Ontario could not find a doctor to care for them despite having a right to treatment under the law. That meant those Canadians received care out of the back of emergency rooms–just like American uninsured.

The moral of the story is that providing universal coverage is not going to be easy. It is going to require innovation, a willingness not to demand every possible service be covered (good luck with that, too), and will require adjustments at all levels of our health care system, including finding a way to produce more doctors, nurse practitioners, physician’s assistants, and the like. Any politician who pretends otherwise is whistling past the grave yard.