Sunday, August 15, 2010

Part One. The Future Fifth Anniversary of Health Reform Law's Passage

March 23, 2015,Washington, D.C. – This is the fifth year anniversary of passage of the health reform act of 2010, the now called Affordable Care Act, or ACA.

To commemorate that historic event, thousands of marchers are crowding the streets to protest reform results on the occasion of its fifth anniversary. In particular, they are upset about lack of access to doctors.

Marchers are the middle-class, the old, and the poor. They are shouting angry slogans. They are carrying placards that read “Doctor! Doctor! Anywhere?” “Obamacare is an Obamanation!” “Waiting to See a Doctor and Not Finding One Is Rationing.” “What Are You Doing to My Medicare?” "Take Back Health Care!" These expressions of discontent may be emotional, even inaccurate, but they are heartfelt and have political resonance and repercussions.

The law promised lower costs, more coverage, more protection against health plans, more choices, more access to care. Instead, costs and premiums are higher, waiting lines to see doctors are longer, emergency rooms are more crowded, and millions of citizens have been forced to change plans and to go onto the Medicaid rolls and to seek care in safety-net clinics or hospitals. The marchers are responding to real results, not to reassuring rhetoric.

These are some of the consequences of good intentions gone awry, and a combination of circumstances, including a bad economy, soaring national debt, a fear of European-type “socialism, ” and disenchantment with the leadership style of President and his perceived disconnection with their interests, have contributed to health reform's unpopularity.

The Obama administration clearly under-estimated the power of market forces, the public will, the political opposition, and a detached management style.

It did not foresee the following.

• The Supreme court might strike down the constitutionality of the individual mandate.

• Major employers and small businesses would drop coverage rather than swallow health reform expenses.

• Insurance commissioners in half the states did not have the authority to enforce the provisions of the law.

• Thirty percent of doctors would stop seeing Medicare and Medicaid patients.

• Increased costs imposed on medical device companies, pharmaceutical firms, and health plans would be passed on to consumers.

• The public by significant majorities would reject their massive health plan because it intervened into their lives and personal liberties, enlarged the role of government, and raised the national debt to unacceptable levels.

Then there was the doctor shortage itself. By 2015, American medical schools, though in the process of expanding from 125 to 140 schools, were still graduating only 24,000 graduates each year, far short of the 50,000 required to care for an expanding and aging population and the huge batch of newly covered patients. Reformers may have forgotten: it takes ten years to make a doctor.

To make matters worse, fewer and fewer medical students were choosing primary care, the entry point for the 50 million or so now being covered by Medicaid, and for the 20 million who would become Medicare-eligible over the next 5 years.

The reasoning of medical students was unassailable: Why work twice as hard at half the pay and half the prestige of specialists when primary care doctors have the same length of training and debts as their specialist colleagues?

Part Two will follow tomorrow.


沛汝 said...

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Richard L. Reece, MD said...

English please. I am Chinese-illiterate. I appreciate your numerous comments, but I don't know how to respond. Who are you? What do you do?

Richard L. Reece, MD