The fundamental question that the Obama administration has never answered is a simple one: How can it treat 50 million new patients with no extra doctors?
A new report from the American Association of Medical Colleges underscores the urgency of this concern. The Association notes that the United States now suffers from a shortage of 15,000 doctors — a shortfall that is expected to grow to 125,000 in 15 years. And, the Association reports, if universal health insurance is passed, the shortage will grow to over 150,000 by 2025.
While the number of elderly people in the U.S. is expected to grow by 60 percent over the next decade and a half, the number of doctors will increase by only about 6 percent (Total U.S. population will rise by about 17 percent over the same period).
This shortage of doctors will, inevitably, lead to the rationing of medical care, more quickly and drastically if the Obama plan is passed. In Massachusetts, where universal health coverage was enacted under Gov. Mitt Romney in 2006, the Medical Society found that the number of patients who reported difficulty in getting care has already risen by 50 percent, up to a quarter of the patient population. The New York Times reports that "a main reason for the logjam was long waiting times for appointments."
In 1949, when President Harry Truman first proposed mandatory health insurance, he coupled his initiative with an expansion of federal aid to medical schools. But Obama makes no provision for an expansion of the pool of doctors, even as he grows the population of patients by up to 50 million.
Indeed, by cutting medical fees by dropping the reimbursement rates under Medicare, he likely will hasten the retirement of many medical professionals, worsening the underlying shortage. The Times quotes medical experts as predicting that the three years specified in the House bill as the time by which universal health insurance coverage will take effect "is not nearly enough time to build the supply of doctors needed to care for the additional tens of millions of people who would become newly insured."
Because there will not be enough doctors, nurses, and medical equipment for the massive influx of patients under the Obama plan, there will be rationing, more draconian year after year. As in Canada, it is this fundamental discrepancy between the number of patients and the population of doctors that will lead to rationing. From there, the inevitable consequence will be cutbacks in care for the elderly. Optional procedures, vital to quality life but not to survival, are likely to be limited. Hip replacements, new knees, hearing aids, and such are less and less likely to be approved. And, medical administrators will be less likely to OK surgery or expensive medical treatments for the elderly, whom they perceive to be at the end of their "quality" years.
It is the shortage of doctors, not any specific language in the text of the legislation, that makes rationing and the so-called "death panels" cited by Sarah Palin inevitable.
We all agree that everybody should have health insurance, but let us precede this step by expanding the number of doctors and nurses so that we can cover everyone without sacrificing the care for anyone. Otherwise, we are not giving 50 million new people medical care. We are consigning 300 million, and particularly the elderly among them, to long waiting lists.
© Dick Morris & Eileen McGann