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The Future Of American Healthcare

You want to see a doctor? You’re going to have to wait. And I don’t mean like an hour in the office. I mean like 53 days.

It’s not some doomsday story from the future. It’s happening today here in Massachusetts. Massachusetts — the state whose 2006 law was the model for the federal healthcare reform law. Massachusetts — home to some of the world’s best medical centers and doctors. And, as the Boston Globe’s “White Coat Notes” blog reports, Massachusetts — home to doctor shortages and long waits to see a doctor:

When primary care patients do secure an appointment for a non-urgent matter, they have to wait to get in the door, the survey found. The average delay is 29 days to see a family medicine doctor, down from 44 days last year, and 53 days to see an internist, up from 44 days last year.

The report said shortages also exist in dermatology, emergency medicine, general surgery, neurology, orthopedics, psychiatry, urology, and vascular surgery.

But what about costs? If you make sure everyone’s covered, you’ve got the foundation for real cost control, right? Unfortunately, no. Healthcare costs have been booming in Massachusetts:

Costs are rising relentlessly for both families and for the state government. The median annual premium for family plans jumped 10% from 2007 to 2009 to $14,300 — again, that’s a substantial rise on top of an already enormous number. For small businesses, the increase was 12%. In 2006, the state spent around $1 billion on Medicaid, subsidies for medium-to-lower earners, and other health-care programs. Today, the figure is $1.75 billion. The federal government absorbed half of the increase.

So what are the lessons for the future of American healthcare?

First, the math is very bad if it is important to you to have easy access to a doctor. Tens of millions new people will have insurance — and a lot of them will use it. Unless there suddenly appear many thousands of new doctors, there simply aren’t enough doctors to care for them. So, as in Massachusetts, the future of American healthcare is going to involve shortages of doctors, and a lot of waiting.

Second, healthcare is going to keep getting more expensive, no matter what. A lot of it has to do with the fact that the trends of the last couple of decades — an aging, unhealthy population, and an increasing availability of new tests and treatments — won’t change. But a lot of it also has to do with the fact that the changes to the private health insurance market embodied in healthcare reform are going to make health insurance increasingly expensive. It’s a combination that means that while you’re waiting to see a doctor, you will have plenty of time to think about how much it costs to see him.

Third, and most worrisome, is whether American doctors and hospitals can continue to be among the best in the world.

As cost control has become the central feature of healthcare over the last couple of decades, the appeal of medicine as a career has been diminishing. But it’s not really about the money — doctors are still well paid and in any case the fees paid to doctors are a small percentage of overall healthcare costs. Rather, the problem is that popular approaches to cost control favor things that undermine doctors’ autonomy to practice medicine. It has a corrosive, insidious effect on a profession whose best and brightest see as a calling even more than a career.

Will America’s best and brightest still want to become doctors if they can find more satisfaction in some other profession?

*This blog post was originally published at See First Blog*

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One Response to “The Future Of American Healthcare”

  1. ‘The best and the brightest’? I doubt it. If you were a college student now, and could visualize where the profession would be in 10 years, would you plunge in? Many wouldn’t and I understand their reluctance. The results of today’s election, in part, are a reaction to the president’s health care ‘reform’ legislation. Most realize that his plan will not control costs or improve medical quality. Will the president realize it?

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