Vince Kuraitis at the eCare Management Blog has put together a great Health Wonk Review this week.  One of the articles that caught my attention was from Bob Vineyard at InsureBlog, about the shortage of primary care docs in MA.  Bob referenced this article from the Kaiser foundation, indicating that PCPs are leaving the profession and that new patients calling for appointments are facing in some cases a four month wait.  That is indeed a problem.

Bob’s take on it is that “The 440,000 or so folks with new insurance cards (many courtesy of the taxpayer) are showing up in droves looking for health care.“  And when you combine this with the basics of economics and the resulting “artificially stimulated demand coupled with a decrease in the number of suppliers” you end up with a problem.  Point taken, but I wonder if there are other factors at work here beyond just the increase in the number of newly insured people in Mass.  If the people need medical care is the demand really “artificially stimulated”?  I’d say that the demand is real, but the ability to pay for it might be artificially stimulated beyond what our traditional so-called free market health care system would allow.

The Kaiser article highlights the problem created when “new patients arrive at PCPs with a long list of pent-up health concerns” and the result is that it takes longer for the PCP to address the patient’s concerns.  Dan Levy, a former PCP who is now a medical administrator, points out that “You have someone on your hands with five separate medical problems, 15 minutes to see them. If you spend the extra half hour, you don’t get paid for it, so the pressure is to refer them to a subspecialist.“  Since docs get reimbursed based on how many patients they see, taking the extra time to help a patient with multiple concerns (often the case when someone has been uninsured for a long time) takes a direct bite out of the doc’s pay.  At the Colorado Health Insurance Insider, we’ve written about how PCPs are an effective weapon in the battle against overuse of technology and increasing costs in health care.  We’ve also written about how a salary (based on quality and outcomes) for PCPs would make more sense than the piecemeal income they currently earn.  And while we’re at it, let’s consider the fact that PCPs earn a lot less money than specialists, even though they all have to go to medical school, and put in their time as slave labor residents.

Those people in Mass who are newly insured and making appointments with numerous ailments and concerns obviously need to see a doctor.  Going back to having them be uninsured would just mean that their list of concerns would grow longer.  Then, if and when they ever became insured again, the ensuing doctor visits would only be more complicated.  It makes sense that after a large group of people join the ranks of the insureds, there will be more of a demand for medical care.  So perhaps the state (and the rest of the country) needs to address the issue of attracting more docs to primary care and retaining them them there.

If we’re going to get around to providing real access to health care to everyone who needs it, we are going to need more medical providers.  PCPs, PAs, nurses, urgent care centers – we’ll need more of everything.  But just because the first state to enact universal coverage (or something close to it) is facing a shortage of PCPs and long waits for health care doesn’t mean that the universal coverage was a bad idea.  That would be a case of throwing the baby out with the bath water.  Yes, it’s created some headaches and there have been glitches along the way.  But scrapping the idea of providing access to care for people that need it doesn’t fix the problem.  It might make wait times for doctor appointments go back down, but that would be an artificial result, since the people without health insurance would have very long wait times indeed – not getting care at all is a long time to wait.