Wait times for seeing doctors have become an issue even outside the VA, which was a totally predictable outcome of ObamaCare. What wasn’t predicted was that the impact on wait times would be seen in emergency rooms, since one of the arguments for ObamaCare was to shift patients out of ERs and into clinics with an expansion of coverage. One California television station reported on lengthening ER waits, and notes that the trade group for ER providers lays the blame on the new health-insurance system:
One of the promised benefits of the Affordable Care Act was to reduce the pressure on emergency rooms by expanding Medicaid and giving the poor better access to primary care.
But instead, a survey by the American College of Emergency Physicians suggests something else.
The organization says President Obama’s health care reform actually has had a destructive effect on the nation’s emergency rooms.
American College of Emergency Physicians, Dr. Jay Kaplin says, “Almost half of emergency physicians polled had already seen a rise in their emergency department visits since January one when expanded coverage of the affordable care act took place.”
And more E.R. visits mean more crowded waiting rooms.
The problem is that the expansion of coverage came while the number of family practice providers has declined. That was a well-known problem even in 2009 before Barack Obama and the Democrats proposed to expand coverage as a means of boosting access. The number of providers in that declining market willing to accept Medicaid and Medicare patients had already been shrinking at that point, too, and that decline has gotten much worse after the passage of ObamaCare. In 2010, just weeks after the passage of ObamaCare, the trend was clear enough to predict this very outcome:
Greater Cincinnati has a shortage of 595 primary-care physicians, according to December data from the Cincinnati MD Resource Center, a free physician recruiting service formed by the nonprofit Health Improvement Collaborative of Greater Cincinnati. The area’s 234 primary-care doctors per 100,000 residents compares to an “optimal” number of 261 per 100,000 that U.S. Department of Health and Human Services data would suggest.
The American Academy of Family Physicians has warned of an impending national shortage of 40,000 such physicians by 2020. About 140,000 will be needed in all to meet the needs of the aging population, the group has said, but current trends suggest there will be only about 100,000.The U.S. Census Bureau puts the current number of uninsured at 45 million.
“People can have all the insurance they want, but if they can’t get in to see anyone, it’s not going to do anyone much good,” Kambelos said.
The New York Times also reported on long wait times across the board. The issue is the provider networks, Elisabeth Rosenthal notes, in both public and private coverage. However, she leaves out one key point:
The study found that 26 percent of 2,002 American adults surveyed said they waited six days or more for appointments, better only than Canada (33 percent) and Norway (28 percent), and much worse than in other countries with national health systems like the Netherlands (14 percent) or Britain (16 percent). When it came to appointments with specialists, patients in Britain and Switzerland reported shorter waits than those in the United States, but the United States did rank better than the other eight countries.
So it turns out that America has its own waiting problem. But we tend to wait for different types of medical interventions. And that is mainly a result of payment incentives, experts say.
Americans are more likely to wait for office-based medical appointments that are not good sources of revenue for hospitals and doctors. In other countries, people tend to wait longest for expensive elective care — four to six months for a knee replacement and over a month for follow-up radiation therapy after cancer surgery in Canada, for example.
In our market-based system, patients can get lucrative procedures rapidly, even when there is no urgent medical need: Need a new knee, or an M.R.I., or a Botox injection? You’ll probably be on the schedule within days. But what if you’re an asthmatic whose breathing is deteriorating, or a diabetic whose medicines need adjustment, or an elderly patient who has unusual chest pain and needs a cardiology consultation? In much of the country, you can wait a week or weeks for such office appointments — or longer if you need to find a doctor who accepts your insurance plan or Medicare.
And those waits are likely to get longer as the Affordable Care Act brings tens of millions of newly insured patients into a system that is often already poorly equipped to provide basic care. “I fully expect wait times to be going up this year for Medicaid and Medicare and private insurance because we are expanding access to care, but we’re not really expanding the system of providers,” said Steven D. Pizer, a health care economist at Northeastern University in Boston.
The point missing from this is the incentives provided by ObamaCare to limit provider networks as a means of cost control. Two months ago, the Associated Press belatedly reported on these cost incentives on insurers and the easily predictable results that follow:
Before the law took effect, experts warned that narrow networks could impact patients’ access to care, especially in cheaper plans. But with insurance cards now in hand, consumers are finding their access limited across all price ranges — sometimes even after they were told their plan would include their current doctor.
Michelle Pool is one of those customers. Before enrolling in a new health plan on California’s exchange, she checked whether her longtime primary care doctor was covered. Pool, a 60-year-old diabetic who has had back surgery and a hip replacement, purchased the plan only to find that the insurer was mistaken.
Her $352 a month gold plan was cheaper than what she’d paid under her husband’s insurance and seemed like a good deal because of her numerous pre-existing conditions. But after her insurance card came in the mail, the Vista, California resident learned her doctor wasn’t taking her new insurance. …
Narrow networks are part of the economic trade-off for keeping premiums under control and preventing insurers from turning away those with pre-existing conditions. Even before the Affordable Care Act, doctors and hospitals would choose to leave a network — or be pushed out — over reimbursement issues as insurers tried to contain costs.
Insurance trade group America’s Health Insurance Plans says studies show the biggest factor influencing consumer choice is price. Insurers say that if consumers want low premiums, their choices may be limited.
Fewer providers with more customers and lower reimbursements mean longer and longer wait times at best. In some cases, it means no effective access to medical care outside of an ER. This isn’t a bug … it’s a feature, and one that will impact more and more Americans under ObamaCare as time goes on.