Will the lack of primary care doctors make universal coverage useless?

It appears that one source of agreement among health reformers is that there isn’t enough primary care doctors.

The New York Times wrote a front-page piece on this issue last month, which I had commented on.  Now, an article in the Washington Post re-iterates the same theme:

As the debate on overhauling the nation’s health-care system exploded into partisan squabbling this week, virtually everyone still agreed on one point: There are not enough primary-care doctors to meet current needs, and providing health insurance to 46 million more people would threaten to overwhelm the system.

As I previously mentioned, the proposed solutions being discussed, like increasing funding to the National Health Service Corps and decreasing the amount of medical school debt, will have very little impact. The combination of Baby Boomers entering Medicare with the potential influx of newly insured patients have the potential to deal the killing blow to our health system.

And even without these obstacles on the horizon, the Post’s piece already paints a grim picture for patients:

Evidence that demand already exceeds the supply of primary-care doctors ripples through the system as patients increasingly have trouble finding a new doctor, then wait weeks or months for an appointment, spend more time in the waiting room than in the examining room, encounter physicians who refuse to take any form of insurance, and discover emergency rooms packed with sick people who cannot find a doctor anywhere else.

Increasing the number of mid-level providers won’t be enough, as their numbers are already accounted for in these dire projections. One way to provide immediate relief would be to entice specialists to shoulder more of the primary care burden, perhaps by providing the financial incentives for them to take on more preventive care responsibilities.

For those who recognize similarities between this post and the comments I made at the National Press Club on July 17th, you’re right.  This post served as a jumping off point to my remarks at Health Care Reform: Putting Patients First, but here are some additional thoughts from after the event.

Shadowfax, an ER doctor whose progressive-leaning viewpoints I highly respect, says the following:

I agree with the sentiment, but I think you have your sequencing backwards.

We can do universal insurance coverage today. It will not be easy, but it is possible, whereas previous attempts have failed over the last 60 years.

Fixing primary care is something we can start today, but even the best efforts won’t show dividends for several years at the very best. That’s optimistically assuming that primary care reforms would even work.

By your thinking, we should allow the 50 million uninsured to languish without any access to health care for another decade until we see if primary care improves?

Both universal coverage and primary care reforms are necessary, but it is not an either-or proposition. Both must proceed on parallel tracks.

Providing universal coverage is an imperative moral obligation, but one that must be accompanied by forceful cost control. Again, I point to the Massachusetts model as the example of what happens when universal coverage takes precedent above all else.

It was recently announced that, because of fiscal strain their health coverage law is placing on the state’s budget, Massachusetts will have to eliminate coverage for 30,000 legal immigrants. So, without considering costs, it is impossible to sustain universal coverage.

I don’t pretend to have an easy answer, and it’s clear that there are passionate opinions on both sides claiming to solve this difficult problem. But I do know that taking the politically expedient route, by promising universal coverage without strengthening the underlying primary care infrastructure first, will be doomed to failure.