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With respect to medical care, far too many Americans make assumptions that have no basis in reality. Two of the most pernicious ones will be greatly exacerbated now that the Affordable Care Act has been ruled constitutional. The first assumption is the idea that having health insurance is the equivalent of having healthcare itself. The second assumption is the idea that doctors will be beholden to the interests of individual patients above all else. Both assumptions are wrong.
First, having health insurance means nothing more than having the ability to pay for one’s health coverage. Coverage itself depends on having access to health professionals. With respect to that reality the numbers don’t lie. The most concerning reality is the additional number of people who will be getting insurance under Obamacare. CNN estimates that number to be 32 million. In addition, another 15 million Americans will become eligible for Medicare in the coming years. At the same time, the United States is experiencing a physician shortage. According to the Association of American Medical Colleges (AAMC), it is a growing phenomenon. By 2015, they estimate there will be a shortage of 63,000 doctors. That number balloons to 91,500 by 2020, and 130,600 by 2025. “The new AAMC projections reflect what happens with a relatively sudden increase in physician demand,” said Scott Shipman, M.D., M.P.H., senior researcher of workforce studies at AAMC. “From a projection standpoint, there is an exacerbated shortage in all areas.”
In 2006, the AAMC called for a 30 percent increase in medical school enrollment. The actual increase amounted to 13 percent. They further note that without an increase in Graduate Medical Education Slots (GMEs), increasing the number of doctors becomes impossible. Obamacare will redistribute a number of unused residency slots. It will also increase funding for the National Health Service Corps, an entity that put resident physicians and other healthcare professionals in health professional shortage areas (HPSAs). As of September 2009, about 65 million people were living in HPSAs — meaning they were already having trouble accessing healthcare. Yet increasing residency slots cost federal dollars, in addition to the cost projections for Obamacare that have already doubled since the law was passed.
Furthermore, medical school costs, which have long outpaced the cost of living, now top $250,000. Such costs are one factor driving medical students into medical specialties, rather than primary care medicine, which saddles would-be physicians with longer hours, less pay, and more administrative problems. That reality has also taken its toll: the number of U.S. medical school students going into primary care has dropped 51.8% since 1997, according to the American Academy of Family Physicians (AAFP). Since primary care doctors represent the front line in medical care, most people will be forced to wait far longer to see a “family doctor”–if they can find one at all.
And those are the people who still want to become, or remain, doctors. According to the St. Louis Front Page: “Despite the projected need for health care practitioners at all levels in a challenging job market, nearly half of high school-age students (45 percent of 13 to 18 year-olds) are not considering pursuing a career in health care and science fields.” Even more frightening, a survey conducted by the Doctor Patient Medical Association reveals a staggering 83 percent of current doctors are thinking about leaving the profession when Obamacare is fully implemented. That is likely an exaggerated number, but the trend is unmistakeable. Moreover, an increasing number of physicians are refusing to take new Medicare patients, because low reimbursement rates–which could go even lower–make it harder to stay in business. “Physicians are saying, ‘I can’t afford to keep losing money,’” said Lori Heim, president of the American Academy of Family Physicians.
Add up the above factors and one thing becomes crystal clear: the assumption that health insurance guarantees timely access to health care is nothing more than a pipe dream.
Which brings us to assumption number two. The traditional doctor-patient relationship is based on the idea that a doctor’s fundamental responsibility is to practice medicine for his individual patient’s benefit. Or at least it used to be. In 2002, the American College of Physicians published a charter declaring that the medical profession “must promote justice in the health care system, including the fair distribution of health care resources.” A 2011 article published in the New England Journal of Medicine declared that “the primacy of patient welfare” should be replaced with a system in which “physicians are collectively caring for a defined population within a fixed annual budget…” In other words, individual health considerations are trumped by those that benefit the collective.
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