More coverage requires more doctors, my take in The New York Times

I was invited by The New York Times’ Room for Debate Blog to give my reaction to President Obama’s health care remarks during his speech to Congress last night.

My piece, More coverage requires more doctors, warns the President that we should heed the lessons from Massachusetts’ health reform experiment.

Universal coverage must go hand in hand with providing better health care access, or else millions of newly insured patients will find themselves going to the emergency room, which paradoxically, will further drive up costs.

Thanks to The New York Times for the opportunity to contribute, and I hope you enjoy the piece.

Comments

J. Ancer
Definitely agree with this. My wife and I moved to Cambridge, MA from Texas so that I could attend law school. She has a chronic gastrointestinal condition that requires monitoring and we were thinking, with Boston being the healthcare mecca of the U.S., gastros must be easy to access. We were shocked to find that not a single gastoenterologist that we could find wasn’t booked for the next 2 months. I’m paying 3x what I paid in Texas in health premiums and I feel like i’m in communist Russia when I try to make an appointment anywhere outside of my university system.
Maria
Congratulations on your appearance in the New York Times, Kevin!
Dr. Val
Nice job, Kev. I liked your point about doctor density in relationship to wait times… how much worse it will be in areas with even fewer docs.
Jeffrey Luther, MD – President, California Academy of Family Physicians
Congratulations, Dr. Pho, on your New York Times comments today. We appreciate your ongoing efforts to publicize the primary care physician shortage crisis. In California, we have a few good developments to report:
The Santa Cruz Sentinel just ran a very good three-day series about difficulties Medicare patients are having finding primary care physicians to see them. Several California Academy of Family Physicians (CAFP) members contributed to this series. They explained the difficult crossroads we’re at when low Medicare payments make it economically impossible for us to see new patients in that program, yet a main reason we became family physicians was to care for people of all ages in our communities. Both patients and physicians are thwarted by the Medicare program’s payment decisions. See: http://tinyurl.com/bshsgo
Judges in two pending lawsuits challenging the State’s cuts in physicians’ and others’ pay indicated this week they may rule against those cuts because of likely harm to patients’ access to care when even fewer physicians can afford to see them. CAFP is a party to one of the lawsuits, California Medical Association v. Sandra Shewry. See:
http://www.californiahealthline.org/articles/2009/2/25/courts-appear-poised-to-reject-cuts-to-medical-reimbursement-rates.aspx
In addition, California’s Legislative Analyst’s Office has determined that in order to qualify for new federal stimulus funds, the State must rescind Medi-Cal eligibility and benefits cuts made since July 1, 2008.
See:
http://www.californiahealthline.org/Articles/2009/2/19/Stimulus-Money-for-MediCal-Hinges-on-Undoing-Eligibility-Rules.aspx
As we work to address the primary care physician shortage, we also must keep the doors open for the physicians we already have.
Jeffrey Luther, MD
President, California Academy of Family Physicians
The Happy Hospitalist
Congrats Doc. We keep getting what we pay for. Why is everyone so surprised?
Stephen Ferrara, NP
Thank you for recognizing that the primary care provider shortage solution must also include NPs and PAs. I am sure that most of us are tired of hearing the banter that often accompanies this topic. I believe the reality is that we can play a role in taking care of the ever increasing number of patients and that we are ready to do so.
Well said!
Anonymous
On the other hand, restricting the accessibility of care is the politically cheap and easy way to ration resources. If new plans require primary care referrals for specialist services, but people are impeded in getting that primary care referral, then huge amounts of money will be saved. The political cover would be a program to encourage/require PCP’s to triage access requests and make sure that timely access is given to those truly in need.
Of course that wouldn’t work well–you can’t diagnose without evaluating–so what it would amount to is allocating care to the pushy and persistent while those less manipulative, more patient, or too sick to fight for care would be rationed out of healthcare altogether.
It is a system that actually works well in some countries–for the government and the healthy.

More coverage requires more doctors, my take in The New York Times

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