Welcome To The Waiting Room

June 11th, 2009 at 8:29 am | 24 Comments |

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As the health care debate heats up, lawmakers are devoting their attention toward “extending coverage.”  While reducing the number of uninsured Americans is certainly a laudable goal, making this the first goal of healthcare reform is to put the horse in front of the carriage.  There are not enough primary care physicians to meet the demand for care among the existing insured population.  Adding 46 million patients without addressing the shortage of care options will overwhelm an already strained healthcare system.  Expanding coverage without expanding care will make an already inefficient health care system much, much worse.

Merritt Hawkins and Associates recently published the results of the “2009 Survey of Physician Appointment Wait Times” which it conducted to determine the average time that new patients must wait before they can see a physician in a variety of large metropolitan areas.  The study found that average wait times had increased by an average of more than a week since the last time they conducted the same survey in 2004.  As the study notes, “The survey is intended to gauge patient access to medical services and may be taken by healthcare professionals as one indicator of the current state of physician supply and demand in select markets and in select medical specialties.”  The vast increase in average wait times is a clear indication that there are simply not enough physicians to meet the demand for care that currently exists.

How bad is it?  On average, wait times have increased by 8.6 days per city. Boston had the longest wait, averaging 49.6 days, followed by Philadelphia with 27 and Los Angeles with 24.2. Residents of Washington looking for care could expect to wait an average of 22.6 days.  In the survey’s conclusion, the authors make no bones about what the survey’s results tell us:

Despite having a high number of physicians per capita, many of these markets are experiencing appointment wait times of 14 days or longer. The survey was conducted during a historic economic recession when physician utilization and hospital admissions are reported to be down. An economic recovery may be expected to increase physician utilization and extend appointment wait times. Boston, a city in a state that recently expanded access to healthcare coverage, shows the longest average times to schedule an appointment. These long wait times serve as a sign of what could occur nationally if access to healthcare is made more generally available through healthcare reform.

Although “Romney Care” (the 2006 health reform initiative that mandates that nearly every Massachusetts resident have health insurance) has not reigned in costs, none other than Massachusetts Senator Teddy Kennedy recently introduced legislation that copies the “Romney Care” measure of requiring Americans to own health insurance.

Adding 46 million people to the existing coverage pool without significantly increasing the amount of care available is nothing short of insanity.  Dr. Richard Cooper, a Professor of Medicine at Penn, pointed out to USA Today that the government is restricting education spending which restricts the supply of doctors yet the government is ambitiously moving to expand insurance coverage and access.  In other words, the government is suppressing supply while aggressively fueling demand.  As Cooper told USA Today, “This [expanding coverage] will demand more physicians. It’s like preparing for a war having previously decided to stop training soldiers. Madness.”

If President Obama and Democratic lawmakers go forward with their plans to create universal coverage without first addressing the already stretched supply of primary care physicians, we can expect to see wait times skyrocket nationwide just as they did in Boston.  If that happens, we are going to find out the hard way that individuals are not going to be willing to wait 50 days; instead, they will go to the emergency room… and when this starts happening, well if you think health care costs are out of control now, you ain’t seen nothin’ yet.  To have coverage without care is to have no care at all.

Recent Posts by Jeb Golinkin



24 Comments so far ↓

  • balconesfault

    I hope that this is intended to be a plea for aggressively expanding the healthcare system.Because if it’s a pitch against expanding healtcare coverage, it’s not going to bring people over to the Republican side.”if we make coverage more accessable to the lower middle class (people with jobs who don’t qualify for Medicaid, but whose jobs don’t provide insurance benefits) that will inconvenience those of us with insurance, Medicare, or Medicaid coverage”.Has there been a good study of AMA culpability in this problem? Acceptance rates into accredited medical schools is about 35-40%, and I’d heard that the AMA controls the number of med schools and slots. This could be a case of essentially a cartel suppressing supply of a needed commodity.

  • ottovbvs

    No one doubts this is a problem. Making an appointment to see the doc usually involves a wait of a few days and if the practitioner is a specialist cancellations are not uncommon. Apparently now its a reason why reform of the healthcare system is no longer possible. Really the excuses and rationalisations are getting very thin Mr Golinkin. And Romneycare has not been a disaster other than in the minds of shills arguing against a universal system. A relation of mine lives in the state and likes it and there have been several polls produced showing the system is popular. Some problems of course but what do you expect with a change this big. The status quo is not an option. If you’d like to give us one I’ll listen but creating obstacles is a waste of time.

  • sinz54

    ottovbs: I also live in Massachusetts, and I like it too. Everyone is mandated to get coverage; and you can’t be turned down for a pre-existing condition.Massachusetts also makes available an inexpensive public plan (MassHealth) for the poor who can’t afford private insurance. But unlike what Obama’s liberals are proposing for the whole nation, the Massachusetts public option is strictly means-tested. Even Social Security Disability payments are counted as income and can put you over the means test. In that way, the public plan can NEVER undercut the private plans for the vast majority of Massachusetts residents. So the private plans continue to do good business with more affluent residents, without any likelihood that this will devolve into a single-payer system.The big problem with the Massachusetts system is that costs are rising. But there are two responses to that: a) Costs are rising everywhere, not just in Massachusetts. b) Deferring cost-containment was by design; only after all stakeholders became comfortable with the system (rather than fighting tooth and nail against it) could cost controls be imposed gradually, step by step, without any stakeholders bailing out.

  • sinz54

    Mr. Golinkin says: “Adding 46 million people to the existing coverage pool without significantly increasing the amount of care available is nothing short of insanity.”That’s odd. A lot of other conservatives have been claiming that those without coverage can still get the care they need at Emergency Rooms. But if that were true, then wouldn’t taking these people away from Emergency Rooms into regular practice leave a lot of Emergency Room doctors with much less work to do? And over time, we will rebalance our system with more General Practitioners and fewer Emergency Medicine specialists?The arguments don’t add up. Either we aren’t given the poor sufficient care now; or after they’re brought into the primary care system, we will have far too many Emergency Room doctors later. (I vote for the former.)

  • sinz54

    Here are some statistics from RomneyCare in Massachusetts:Uninsured residents: Declined from 8% before RomneyCare to under 3% with RomneyCareLower-income uninsured residents: Declined from 24% before RomneyCare to 13% with RomneyCareSpending on “Health Safety Net Fund” (which treats the uninsured in places like Emergency Rooms) declined 38%

  • balconesfault

    sinz: “So the private plans continue to do good business with more affluent residents, without any likelihood that this will devolve into a single-payer system.”Or as some would say – “evolve into a single-payer system.”Although I certainly favor people always having the option to purchase better quality coverage outside of any single-payer system.

  • ottovbvs

    sinz54 wrote 15 minutes ago…..Sinz we agree….how can I handle that

  • barker13

    Jeb,Here’s the deal, son…(*SMILE*)If you’re gonna throw out a statement such as Romney Care…has been a catastrophe…”…you sure as heck better be prepared to back that statement up.Now my understanding is that your statement is more fact than fiction, nevertheless, fair is fair and I hold “my side” to the same standards as I do “their side.”So com’on… make your Uncle Bill proud!BILL* Hey Mike… hey Dave… you’ve both GOTTA join this thread!

  • ottovbvs

    barker13 wrote 31 minutes ago”Now my understanding is that your statement is more fact than fiction,”……Based on what…..another report from the Cato institute….a Rove oped in the WSJ…..Limbaughs latest exposition of the facts

  • SFTor

    This issue has become a macroeconomic and national strategic issue. This country will lose its ability to compete and much of its ability to stay safe unless the health care problem is solved. Maybe there are too few doctors. Fine. But then let’s do something about it. There are a whole number of health care models out there that seem to work, everything from straight socialized medicine in Finland to hybrid models in Norway, Germany, and Switzerland. There has to be one of them that can be implemented in the U.S.My sense is that breaking up the single-payer system by state may have some merit to reduce the size of it. But 46 million people, among them 9 million kids, relying on emergency room care is no way to run a country.

  • darnoc52

    This is your excuse for leaving things as they are? Our medical delivery system is a business, nothing more. There aren’t enough primary care physicians because of simple, capitalist (aka “free market”) imperatives. If our economic system offers more rewards for doing boob jobs than attending sick children then bring on the knockers and damn the kids. The point of universal health care as a shared responsibility of citizenship is to change this dynamic. Being a “progressive”, I actually believe in human progress, unlike some who fall back on the social-Darwinian crutch. We can produce those PCP’s, so that a human being that calls him/herself an American that gets sick should be able to go to the doctor…period. That is what is characteristic of the decent and humane country I love.

  • InTheMiddle12

    You have got to be kidding me. What a ridiculous argument to think that we shouldn’t increase access because people will have to wait longer. If that is in fact an issue to be faced, which I highly doubt, the answer is to encourage, through tuition support, more medical professionals. I don’t know of one medical school that is easy to get into in this country.The only reasons I’m glad to see this argument presented is because it shows how low the right will go and their amazingly crazy attitude toward those without the means to afford healthcare.Trust me, those without health insurance that end up brankrupt from one illness will be happy to wait a few extra days for service that won’t leave them broke. How spoiled can you possibly be? Deny others healthcare because you’ll have to wait a few days rather than try and fix that too! Sadly, typical.

  • GoramFirefly

    Sinz said: “I also live in Massachusetts, and I like it too. Everyone is mandated to get coverage; and you can’t be turned down for a pre-existing condition.Massachusetts also makes available an inexpensive public plan (MassHealth) for the poor who can’t afford private insurance….the Massachusetts public option is strictly means-tested.”That sounds reasonable to me. I could live with that.However, how inexpensive is inexpensive? To wit, if someone loses their job, and does not have any income whatsoever, (whilst presumably looking for another means of employment and hence has no ability to pay anything) are they, and their children, still covered?

  • GoramFirefly

    Sinz: Another question (or two or four): How poor does one have to be for MassHealth? What I mean is, can someone still own property, i.e. their primary residence, and still qualify or do they have to be completely without assets and basically destitute?What about someone who is bringing in say, $30,000 a year, but still cannot find affordable health insurance? Is there enough choices available to them? Or is this really a non issue?If one does have a pre-existing condition, do they have to pay substantially more, on average, under this mandated regime (I realize that there are probably many insurance companies to choose from, so there might not be an absolute answer to this)? If so, what happens to those people who still cannot afford it? Especially, if they are earning decent money in relation to the means testing? Can they qualify for MassHealth?What is the effect of the mandate on insurance prices in general? Is it reducing them, increasing them or are they about what they would have been with out the mandate?I’m curious now. I’ll probably have more questions later.

  • sinz54

    GoramFirefly: With Massachusetts RomneyCare: If you lose your job, and have little income from other sources, then you may quality for the state plan, CommonwealthCare. It covers everything, including prescriptions. It has the “look and feel” of any private plan, including a 24×7 phone help line–not like a Government bureaucracy at all.By Massachusetts state law, no resident is penalized for having a pre-existing condition. Neither with CommonwealthCare or private plans. In my case, I switched to BlueCross some time ago after RomneyCare went into effect. Their Massachusetts online application form didn’t even *ask* me if I had a pre-existing condition (which I did), or any questions about my current state of health. Neither did their phone representatives. The issue just didn’t come up. For CommonwealthCare, the public plan, premiums are on a sliding scale based on income–but even such things as Social Security disability payments are counted as “income.” If your income is below $10,000, your monthly premium is ZERO. If your income is up to $32,000, your monthly premium is about $140. If your income is over $32,000 (say from interest on a big bank account), then you don’t qualify for this plan.So this plan is really for the truly needy. And so it can’t drive the private insurers out of the market for middle class and upper class citizens.You don’t have to be without *assets* to qualify for this plan, so you’re not going to lose your home or car. But you do have to have less than $32,000 of total *income*–so if you have income-producing property producing more than $32,000 of income, you don’t qualify.For the uninsured who wish to purchase private insurance on their own, these reforms have actually *lowered* premiums:http://en.wikipedia.org/wiki/File:HealthReform.jpgHope this helps.

  • sinz54

    The irony of RomneyCare, is that here’s a *Republican* governor, who successfully implemented the kind of health care reforms that Hillary failed at, and that during the 2008 campaign Obama could only make vague promises about. He got nearly everybody in the state covered, and created a nifty public plan for the needy, without driving the private insurers out.But the GOP base believes that any government initiative in this area is “socialized medicine.” So as candidate for President, instead of running on his achievement, Romney was forced to run away from it. It ended up adding to his image as a flip-flopper, which is a big reason he failed to get the GOP nomination.

  • Jeb Golinkin

    You folks are right. “Catastrophe” was certainly poor word choice. The point I was attempting to convey was that Romney Care has not reduced health care costs, as many of its proponents claimed it would….I have changed the wording….your objections on that point were well founded.To address another point, the wait times are not problematic because I am upset that I will have to wait a little longer to get care, the wait times are problematic because it will drive routine patients who ARE unwilling to wait to the emergency room. If we extend coverage without also increasing care options, we have no chance of controlling costs. Of course we need to extend coverage….but we need to do so while increasing care options.

  • ottovbvs

    sinz54 wrote 48 minutes ago”The irony of RomneyCare, is that here’s a *Republican* governor, who successfully implemented the kind of health care reforms that Hillary failed at, and that during the 2008 campaign Obama could only make vague promises about. He got nearly everybody in the state covered, and created a nifty public plan for the needy, without driving the private insurers out.”…….Actually as you well know Sinz if you live in the state the bill was largely written by the legislature. Romney certainly was not the architect of this scheme although he wasn’t massively obstructive and worked in a constructive way with the house/senate. The real irony is that he essentially denied having anything to with the plan when he ran for president. Did the cock crow three times I wonder? When he was on the campaign trail Obama didn’ have to provide all the detail just a committment that he would introduce it. Obviously the bill would ultimately be written by congress.

  • ottovbvs

    JebG wrote 15 minutes ago”the wait times are problematic because it will drive routine patients who ARE unwilling to wait to the emergency room.”…..Except that as others have pointed out that has not been the effect in Mass. Essentially your case boiled down to the fact that a shortage of primary care physicians was going to create inconvenience for those with health insurance who would have to wait longer for appointments and this was sufficient reason to derail the push for reform…..Doesn’t really stack up does it.

  • sinz54

    ottovbs: In Massachusetts, health care reform had a long and complex history. http://tinyurl.com/kkq8trThe Massachusetts legislature first announced they wanted to to cover more of the state’s uninsured. Then Romney proposed his own outline of a plan that would insure virtually all of the uninsured.http://tinyurl.com/kkc4gqThe Massachusetts legislature came up with a plan that differed from Romney’s plan in some areas, which Romney tried to veto but failed. http://tinyurl.com/lqdwnfBut in the end, he signed it into law as is.

  • sinz54

    JebG:Are you kidding???When you go to an Emergency Room for routine care or even urgent care, you sit and wait–and wait–and wait. These days, every Emergency Room has a “Triage Coordinator” who first takes a look at you and your problem, and decides if it should be “fast-tracked” or not. And only those with life-threatening conditions like bleeding or asthma attacks are fast-tracked. Otherwise you go back out to the Waiting Room–and wait some more. You can waste most of a day waiting there (so much for your job productivity).As for rising costs: Romney and the Mass legislature had made a deliberate decision to *defer* strong cost controls until after health care reform went into effect. If they had put cost controls up front, it would have scared stakeholders like hospitals and insurers, and made it much harder to enact the plan. Now that residents have gotten used to health care reform, Governor Patrick and the legislature can gradually start imposing cost containment–little by little, giving everyone time to adjust and to bring in such innovations as computerized networked databases to lower costs. It is also hoped that better preventive screening, now available to the uninsured through the public CommonHealth Care plans, will help lower health care costs eventually. That last is kind of iffy. Because you may prevent one illness, but eventually you’ll get another. The Grim Reaper can’t be put off forever, no matter how much someone focuses on wellness.As Sanford once said in the TV comedy “Sanford & Son”: “What’s he gonna do when he’s an old man, lying in a hospital bed, dyin’ of nothin’?”

  • Jeb Golinkin

    So you think that someone with the flu would rather go untreated than deal with the hassle that is the ER? When the options are (a) ER (b)wait two months (by which time you will be over whatever you’ve got) or (c) do nothing, I think its a pretty safe assumption that not everyone is going to take the “tough it out approach.” You mention that you can blow an entire day in the waiting room of an ER, well if you have the flu and you don’t get treatment you will be out of commission even longer….most people will take that day if the other option is to go untreated (and again, with something like the flu….a 50 day wait= not getting treated) I’m all for extending coverage but you’d sure as hell better encourage the growth of the convenient care industry so that doctors and ER patients can spend their time seeing patients with serious illnesses. It makes no sense to have a doctor take an appointment with someone with the common cold when a nurse practitioner will identify the same basic symptoms and proscribe the same medication to treat those symptoms that a Dr. will. If the symptoms are less clear, then the nurse practitioner sends the patient to see a Dr. with more extensive training to diagnose the more complex illness. There are actually machines that, if you type in your symptoms, can diagnose basic illnesses.My point is not “don’t expand coverage.” It is rather that expanding coverage in and of itself will not result in decreased costs. We have to address coverage to make more care available otherwise health care reform will fail.

  • GoramFirefly

    Sinz,Thank you for your detailed account. Yes, it helped very much. I live out here in California, and the only thing I heard about the Massachusetts system was that “it mandates everyone to buy insurance” and that was it. Needless to say, that didn’t sit well with me. Your account puts it in a totally different light.Thank you.

  • KL7212

    “To have coverage without care is to have no care at all. ” This is silly. Nobody who falls and breaks his leg or has a heart attack is going to wait for treatment by a primary physician; He’s going to the ER. The “waiting time” argument against the Obama plan is a canard, especially since we already have extended waits for primary and emergency care are largely due in no small part to the huge number of uninsured patients clogging the system. I think a “two-tier” system might work. Those who need just basic coverage will get it, free of charge or at low cost through a publicly funded plan. Those who wish to purchase a higher level of care can do so through their employers or out of their own pockets.Most everybody agrees the current system is badly in need of reform. It is hideously expensive and inefficient. It combines the worst aspects of capitalism (profiteering, cost cutting) and socialism (rampant bureaucracy, rationing). It is geared more towards catastrophic care rather than preventative care. Worse still, the outcome yielded by this health care monstrosity–life expectancy–is no better and, in many cases worse, than that of public health care systems offered in other affluent nations.