Driving home Sunday night stuck in the Pike traffic I heard this NPR story, Mass. Health Care Reform Reveals Doctor Shortage. It pushed a button in me, something that has been brewing for months. Am I overreacting, or is this real?
The story follows a familiar trajectory. Yes, health reform has increased coverage by some 440,000 people in Massachusetts. But the shortage of primary care doctors is an unintended consequence that raises fundamental questions about health reform. This same story has been told by the Wall Street Journal (Doctor Shortage Hurts A Coverage-for-All Plan: “The dearth of primary-care providers threatens to undermine the Massachusetts health-care initiative”) and key bloggers (“This shortage is already crippling health reform in Massachusetts.”). Even I’m not immune from the meme: “Among the ‘real challenges with national implications’ stemming from Massachusetts health reform is not simply cost, Rosman said, but a shortage of primary care providers.”
A Google search for brings up 227 hits. One more example: we were recently called by a producer from the PBS NewsHour with Jim Lehrer. They are doing a story on potential national health reform, and wanted to use Massachusetts to illustrate the shortage of primary care. We pushed back, saying the relevant stories here are the impact of the individual mandate, or the lack of employer coverage crowd-out, or the continued support from stakeholders. The producer said sorry, we know what we want, and went to someone else to make their point.
Here’s our point. Yes, there is a shortage of primary care in many parts of the country. It’s particularly bad in Western Mass, the Cape, and some other areas of the state. This preexisted health reform, and is related in part to the poor reimbursement for primary care (see this, BTW, from Sunday’s Globe, including video, on group visits as one way to make up for reimbursement concerns). The legislature has taken some steps, stakeholders are engaged, and more needs to be done. We’re still waiting for the first meeting of the payment reform commission, tasked with improving primary care reimbursement.
The anecdotes are troubling, but the statistics, from Sharon Long’s study, are modest. The number of people who said they “Did not get needed care in past year because of trouble finding a doctor or other provider who would see them or trouble getting an appointment” went up from 3.5% to 4.8%.
But isn’t it still much better to have more people covered by insurance, though there may be not enough primary care clinicians, than to have more people uninsured, and still not have enough primary care? The shortage of primary care is not a consequence of health reform; it was always there. Why are the two connected? Why are primary care workforce issues trotted out as a reason to be wary of health reform, of covering the uninsured?
I guess I have to agree with John McDonough (yeah, I know), quoted in the NPR story today: “What has happened is that Massachusetts health reform has put a spotlight on the workforce shortages that don’t get meaningfully talked about in just about any other state,” McDonough says.
What do you think?
Brian Rosman, with Lindsey Tucker