Wednesday, December 19, 2007

Be careful what you wish for, you might get it

The Massachusetts version of a socialized medicine healthcare plan is often cited as the template for the Schwarzenegger-Nuñez California state-wide healthcare plan so it’s interesting to look at the Massachusetts plan to consider its effects on their residents; and it is not a pretty picture.

For example, on the day one person signed up for the Massachusetts plan, she called more than two dozen primary-care doctors approved by her insurer to try to get an appointment and all of them turned her away.

Her experience is common among the 550,000 uninsured people for whom Massachusetts had expected to provide healthcare. The newly insured will be trying to get medical attention in a state with a "critical shortage" of primary-care physicians, according to a study by the Massachusetts Medical Society released yesterday, which found that 49% of internists aren't accepting new patients. For those residents lucky enough to get an appointment with their primary-care doctor, the average wait is more than seven weeks, according to the medical society, a jump of 57% from last year's survey. Boston's top three teaching hospitals say that 95% of their 270 doctors in general practice have halted enrollment.

Having insurance for healthcare won't mean anything if you can't get a doctor appointment; and getting an appointment to see a specialist is even more difficult and with still longer waits being the norm. To make matters worse, prior approval from the difficult-to-get primary care doctors is required before you line up to see a specialist.

This experience in Massachusetts will likely be repeated in California where, in addition to the problems facing doctors in that Massachusetts, doctors in California will be expected to pay for the California plan through new ‘fees’ levied on them (along with additional ‘fees’ to be paid by hospitals in the state). Physicians already are burdened with continually reduced reimbursement from Medicare and Medicaid and now they will see their revenue reduced even further by new taxes disguised as ‘fees’. It will be no surprise if medical practitioners choose not to set-up shop in California, and those that are here will retire earlier.

Nationwide primary-care doctors, including internists, family physicians, and pediatricians, are in short supply. The number of such doctors dropped 6% relative to the general population from 2001 to 2005, according to the Center for Studying Health System Change in Washington. The proportion of third-year internal medicine residents choosing to practice primary care fell to 20% in 2005, from 54% in 1998.

One reason for the decline in doctors is that they get less money for more work. Median income for primary-care doctors was $162,000 in 2004, the lowest of any physician type, according to a study by the Medical Group Management Association in Englewood, and their income droped strikingly after 2004 as insurance reimbursement declined. Income of specialists like cardiologists and radiologists is also dropping. Moreover, after managed care started in the mid-1990s, doctors have an added burden because insurance companies require primary-care doctors to serve as gatekeepers for their patients' referrals to specialty medicine. Why should newcomers enter a field where government pressure lessens income potential after undergoing many years of education and qualifying in resident programs while their responsibility continues to increase?

Under the Massachusetts and California socialized medicine programs, medical insurance is mandatory for all residents, whether they want it or not. Residents in Massachusetts who don't get covered pay a penalty on their state taxes, and companies with more than 10 employees face a fine for each worker to whom they don't provide insurance. The California healthcare law also mandates everyone to have insurance. Although penalties for failing to get insurance in California are not yet known, you can be sure there will be a ‘cost’ to those that don’t comply.

As the lady that looked for a doctor in Massachusetts said - "I thought (health) insurance was supposed to be some kind of great thing, but it hasn't changed". The lesson to those that expect ‘free’ medical care is: ‘Be careful of what you wish for, you might get it”; and it won’t be ‘free’.

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