The “doctor shortage” is not due to the success of the MA plan. It’s due to no forethought or planning on the part of the architects of this plan. That’s because the plan wasn’t about health CARE; it was about making sure everyone in the country would be insured, as in BCBS Insure America, and MA was the “experiment” to show that threatening people with penalties would do it – well, sort of do it – about 300,000 are still uninsured. This number includes those who received offical permission, those who were exempted due to lack of affordable plans, many who can’t afford the insurance, those who don’t like the Federal regs attached to the Comm. Care plans and those who refuse to be bullied or any combo thereof.

Back to the doctor part:

a) if a Commonwealth Care member can’t find a primary care doctor within a reasonable distance from home or work, then health care becomes a problem due to having to take too much time off from work and gas/tolls. People don’t have money for these extras. They can’t even afford food and heat for the past several years.

b) if a Comm. Care member can’t have a choice or see the doctor they’ve been treated by and trust (prior to this law), then they either are not going to comply with the law b/c it’s a waste of money – they’ll have to pay out of pocket to see their doctor and can’t afford to pay premiums and do this, or they won’t seek care b/c they don’t like the only doctor two towns down the line who will take them.

c) some women aren’t getting their annual PAP and internal b/c they aren’t allowed to see their previous gyn. Again, no choice and so much for the stated goal of preventive care.

d) if a member has been seeing a specialist for many years for a particular ailment prior to this law, and that specialist won’t take Comm. Care patients or isn’t in the network, that is a major problem for the patient. Problems like this cause stress which is really bad for one’s health, especially when they are already battling disease.

The state forces people to purchase insurance, but, in reality, the products don’t deliver and also violate freedom of choice. There are doctors who won’t take Comm. Care patients any longer b/c permission is needed for a simple blood test, there’s too much paperwork or they can’t afford to pay overhead and/or hire more staff b/c of the low rates.

Many patients have only one choice of places to go, if any, and that is a local community health care center. Where I live, the one center is now open 7 days and is a virtual factory. I won’t go there. I also read that the state is going to offer incentive for nurse practitioners and doctors to come to MA. Do you think that residents should be intimidated into purchasing insurance and wait around x number of years or be told they must see only nurse practioners when, in fact, they prefer to see a doctor? Nothing personal about nurse practioners – but it boils down to choice yet again.

Take this mess national, and millions will be hurt, but their voices won’t be heard b/c politicians don’t care about lower income people. Think Katrina.

P.S. Comm. Care patients not seeing doctors saves the state and insurers money.

p.s. – I sometimes describe the trichotomy in our health care system – with research and innovation organizations being the third component.

In western Mass the shortage does pre-date health care reform, and has been made worse by it, in perceptions of availability, confusion over which office accepts what insurance and in numbers of available visits.

I’m not sure it is better to have health insurance that doesn’t help you see a doctor, especially if you are paying for it. The resources required to do good enrollment and retention of health coverage may be squandered when once a person has access, they can’t get an appointment. Do we know how other resources, like volunteer physician networks and prescription assistance programs, are fairing? Are these still available given the perception that coverage is near-universal?