Opponents, critics and even some supporters of health care reform continue to speculate on potential glitches in the delivery of health care to the millions of Americans who otherwise would have gone without access to medical care. The latest gloom and doom prediction is that national health care reform will cause longer waits and add to the existing problem of overcrowding in hospital emergency rooms because of a perceived shortage of primary care or family physicians.
Is this true? Why aren’t there enough primary care physicians to go around?
One of the biggest reasons is that fewer and fewer medical students are choosing that field of medicine. “Family doctors” work longer hours for less money than most other specialties. These days, young doctors graduate medical school with $120,000.00 or more in student loans or debt, which makes the higher salaries offered to surgeons and other specialists more appealing. It is especially tempting to go into sub-specialties such as sports medicine that mostly serve the financially secure and well-insured patients.
Another reason for this shortcoming is that primary care physicians tend to have higher administrative overhead than other doctors. They need a staff to handle the insurance company paperwork more than other specialties. They are also the ones to sign notes to employers and school principals about absences, requests for handicapped parking stickers, etc.
For the past several years, the standard “solution” to alleviate the doctor shortage offered by conservatives and anti-reformers is tort reform. The message is repeated ad-nauseum and hammered into the public awareness from every conceivable angle. Their reasoning as to why there aren’t enough doctors is that physicians are being driven out of medicine by high malpractice insurance costs. But the truth is that many of the specialties attracting younger doctors have much higher malpractice insurance costs than primary care.
Another theory offered by anti-reformers is that if government just got out of the way, the “free market” and the law of supply and demand would eventually even everything out. But in a way, the law of supply and demand has made the problem worse for consumers of medical goods and services. As more and more Americans lost access to insurance benefits due to claim denials, policy cancellations or ever escalating premiums, the system no longer responded to their health care needs. When “demand” for medical care comes only from people with the best insurance and highest income, the system supplies plenty of plastic surgeons and sports medicine specialists but not enough family doctors. This is a complex issue, and the real solution probably will include education subsidies and other incentives for young doctors to stick to family medicine.
Here’s what the American consumer of medical services should contemplate as we move into a new era of health care delivery. First, “tort reform” unfairly punishes the people who are most damaged by the negligence or carelessness of others. Second, rare and devastating diseases that are unprofitable to treat would be ignored by a “free market” system.
As the many provisions of the health care reform bill go into effect, we will hit some rough patches. People who oppose reform will use every one of those rough patches as arguments for scrapping reform going back to the old system, and enacting legislation to limit access to the courts by those injured or killed by medical errors. When you begin to hear the cries of the anti-reformers, just remember that the old system of supply and demand in the context of medical care seemed to “work” only because so many people were cut off from it by lack of insurance. More important, is to remember the Amendment 7 in the Bill of Rights to the constitution that states:
In suits at common law, where the value in controversy shall exceed twenty dollars, the right of trial by jury shall be preserved, and no fact tried by a jury, shall be otherwise reexamined in any court of the United States, than according to the rules of the common law.