Obamacare- The Next Hurdle? The Shortage of Doctors

It’s interesting. The country has been debating the pros and cons of the Affordable Care Act since it began in 2010. Unfortunately, until the discussion became relevant to the broader population the general public had remained largely detached.  Yes, some good things have come out of the law to help some of those with pre-existing conditions and to help the system finally start to work on prevention. But many questions about how all the pieces are going to fit together remain.

The debate about health care has been primarily political instead of looking out for what is good for the country and its citizens. Neither side has been willing to try to fix the cumbersome, complex, and expensive law that was enacted. It’s been all or nothing for both and we’re now living with the consequences.

I’ve been following the ACA since the beginning and I’m not all that surprised with the failure of the www.Healthcare.gov web site to work. The processes we are using to manage our government systems are dysfunctional- and the website rollout is a product of that dysfunction.

The country is now focused on www.Healthcare.gov because of the poor implementation and execution of a fundamental feature of the legislation. This rollout was very visible to most, and health care suddenly became more relevant to many.

But, www.Healthcare.gov is only the beginning. Once the site is fixed and running, more individuals will be participating in the broader health care system than before. The website is simply the pipeline for access into the delivery system.

What then?

The most likely answer lies in Massachusetts. After a similarly difficult rollout in the beginning, over 96% of all Massachusetts residents now have health insurance.  But they are facing other problems.

The Massachusetts Medical Society released two reports (2013MMS Patient Access to Care Study; and 2013 Workforce Study) that are likely indicative of what will happen nationally once more individuals enter the health care market.

In 2013, wait times in Massachusetts to schedule appointments with providers ranged from 22 days to 50 days for more routine services. Only 45% of internal medicine practitioners and 51% of family medicine practitioners are now accepting new patients. And a quote from one study states, “With no intervention, health care spending in Massachusetts will double by 2020.”

Even before the ACA was implemented, the country was projected to experience a significant shortage of primary care physicians by 2020. With more people entering the system, that shortage may occur much sooner. Obamacare will certainly be blamed- some of it justified for not addressing the problem before adding to it, some of it not because the problem existed anyway.

Consumers need to be prepared to wait longer and may have to spend more time finding a physician. In some cases (and regardless of the sales pitch) you may not be able to keep your doctor due to the realities of the market. It’s a simple matter of supply and demand.

Be prepared. And don’t be surprised or shocked when it happens. The politics of Obamacare is one thing, the reality is another.

Obamacare- Neither Side Has The Right Answer

In June, 2013 the Government Accountability Office presented a report regarding the overall status of the federally facilitated health insurance exchanges. This report covered the overall project status for the 34 states that were going to rely exclusively or partially on the federal government (CMS) to establish and maintain their health insurance marketplaces. The GAO was somewhat concerned back then. The report stated, “. . . and the many activities yet to be performed- some close to the start of enrollment, suggest a potential for challenges going forward.” We’re certainly going to have challenges going forward and nobody should really be surprised what has happened.

For the past 3 years we have heard the Republicans vowing to repeal the Affordable Care Act (Obamacare) with no vision or plan for replacement. Today, we heard President Obama and those on the left communicating that with the exception of the federal exchange (Healthcare.gov) everything is great in Obamacareland. Neither side is facing reality.

I was actually a supporter of the Affordable Care Act when it was passed in 2010. Finally, the country was going to do something to address the unsustainable health care costs in our country. Finally, the country was going to do something to help prevent individuals from losing everything because of the devastation created by a health care event. Finally, the country created a path to do something that would begin to get rid of the waste and inefficiency that everyone knows exists in the health care system today. I didn’t agree with the approach (getting everyone into an already broken system and then fix the system later) but at least the potential existed to make the changes that needed to be made. I was willing to give it some time.

Yes, the Affordable Care Act is the “law of the land,” yes, the ACA has survived Constitutional scrutiny from the Supreme Court, and yes, Romney wasn’t able to produce an alternative approach during the election last year. But it’s difficult to support an idea that has been communicated and implemented so poorly, fails to acknowledge its deficiencies, and doesn’t sound like its open to new ideas to help improve how it works for Americans.

Obama finally held a press conference that (I thought) was going to acknowledge the existing flaws, address the real misperceptions existing with and about the ACA, and the steps that were going to be taken to get it back on track. I thought he would certainly recognize the deficiencies existing with the federal Healthcare.gov web site, the challenges some employers are facing to implement the law, the disagreements many have with some of the requirements of the law, the reasons some individuals are experiencing “sticker shock” attributed to some of the features of the law, and the general confusion surrounding the intent of the law itself.  I thought he would finally be selling the broader purpose- the need to reform our health care delivery system for the good of the country and our economy- as opposed to simply selling health insurance.  He opted to just sell health insurance and trash the opposition.

The president was right when he stated the Affordable Care Act is more than just a web site. Some of the early features of the law have already helped many individuals (uninsured and those with pre-existing medical conditions). However, to get the general public engaged is going to require a providing a broader understanding of the steps that are needed to fix the mess that exists in our health care system today. It’s time we faced reality and acknowledge some things need to be fixed in the ACA and it should require collaboration and ideas from all sides. Health care reform should be about working together with all stakeholders to achieve a common goal for the country.  In 2010, I naively thought there would be some collaboration to fix what needed to be fixed in the ACA. That is obviously not where this is heading.

Reforming health care is not just trying to get people to go to a web site that does not work to buy health insurance. Unfortunately, that’s the message President Obama sent today and the flaws of the ACA are going to remain. The country will end-up paying for it.