Health insurance and the shortage of doctors
There’s a major irony in the Tea Party’s push to scale back Big Government. The assumption seems to be that the Federal Departments and Agencies do nothing to support or promote services in the states. Yet without someone in the center pushing and coordinating what the states do, all decision-making will be driven by what satisfies the needs of each state. The idea one state might willingly do something to benefit other states would likely disappear. So let’s take the problem of providing enough doctors. Nationally, we can look at what happens in other developed countries and aim to match their performance. Note we say “aim” to match. The Federal Government’s powers are actually quite limited. The result is that we have one of the most expensive health care services in the developed world, but one of the smallest numbers of physicians per capita. America spends almost $7,300 per person on health care. The average in the thirty wealthiest countries is less than $3,000 per head. For all this extra money we get fewer physicians. We have 2.4 physicians for every 1,000 people. The international national average is 3.1 per 1,000 people. Some countries spending a third less than us have up to 4 doctors per 1,000. That’s one of the reasons why our life expectancy is poor and the infant mortality is the worst in the OECD countries. The irony is that all the other major economies have single payer systems and full government control. That’s why their people get better medical care than we do.
The current estimate from the Association of American Medical Colleges is that we will be short more than 60,000 doctors come 2015. By 2025, the shortage will have grown to more than 130,000 as many of the older physicians retire without any increase in the training system to replace them. As we currently find ourselves, there’s effective rationing, i.e. the waiting times for an appointment are increasing as we queue to consult a declining number of physicians. Why, you ask, is this not more obvious. The answer is the number of uninsured people. Again according to the latest estimates, more than 40 million adults are without any form of health cover. Most cannot afford to pay for routine appointments with their regular doctors. They are forced to wait until their symptoms can be classified as an emergency. Now consider what will happen when the number of uninsured falls as the implementation of the Affordable Care Act continues. According to the Congressional Budget Office, assuming the Act is constitutional, more than 30 million adults will gain access to some level of cover by 2019.
The solution to this problem is going to require a major change in the policy of the medical schools to expand their operations. It takes between five and seven years to produce a trained doctor. This means expanding operations as from the next academic year if we are to begin closing the gap. Indeed, truth be told, we actually need more medical schools although it’s not clear where all the professors would come from to deliver the education and training content. Making cheap health insurance available to millions more may break the current health care service. Remember this when you get your next health insurance quotes. Having insurance does not make it easy to see a doctor.
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