The PJ Tatler

The Coming Crisis in Patient Access to Physicians

The reason is Obamacare, of course, and the problem will be faced by almost every state in the union. For big states like California, the situation threatens to be so bad, people may be forced to go out of state for medical care.

From the Los Angeles Times:

Some lawmakers want to fill the gap by redefining who can provide healthcare.

They are working on proposals that would allow physician assistants to treat more patients and nurse practitioners to set up independent practices. Pharmacists and optometrists could act as primary care providers, diagnosing and managing some chronic illnesses, such as diabetes and high-blood pressure.

“We’re going to be mandating that every single person in this state have insurance,” said state Sen. Ed Hernandez (D-West Covina), chairman of the Senate Health Committee and leader of the effort to expand professional boundaries. “What good is it if they are going to have a health insurance card but no access to doctors?”

Hernandez’s proposed changes, which would dramatically shake up the medical establishment in California, have set off a turf war with physicians that could contribute to the success or failure of the federal Affordable Care Act in California.

Doctors say giving non-physicians more authority and autonomy could jeopardize patient safety. It could also drive up costs, because those workers, who have less medical education and training, tend to order more tests and prescribe more antibiotics, they said.

“Patient safety should always trump access concerns,” said Dr. Paul Phinney, president of the California Medical Assn.

Such “scope-of-practice” fights are flaring across the country as states brace for an influx of patients into already strained healthcare systems. About 350 laws altering what health professionals may do have been enacted nationwide in the last two years, according to the National Conference of State Legislatures. Since Jan. 1, more than 50 additional proposals have been launched in 24 states.

Don’t listen to Obamacare apologists who say that this problem was unavoidable. It was easily avoidable if Congress had taken a prudent, incrementalist approach to the problem, phasing in Medicaid coverage over five or ten years, allowing the supply of doctors to rise in concert with the increased number of people being insured. Incrementalism was a no-brainer that liberals rejected because they were so enamored of “making history.”

I reject the argument that incrementalism would have been “too hard” to accomplish and the easier course was to affect the changes all at once. Altering society in such a fundamental manner should be hard — must be hard. Force-feeding such enormous changes without the slightest hint of what much of the real-world impact on people’s lives and pocketbooks will be is irresponsible.

To a lesser extent. much the same could be said of the financial services reform bill — Dodd-Frank. Here too, there were problems that needed to be addressed — that could have been addressed — without resorting to creating a gargantuan new agency, the Consumer Financial Protection Bureau. Besides, the real problems regarding “too big to fail” and the transparency of the derivatives market were inadequately addressed.

The common deficiency that defines both Obamacare and Dodd-Frank is imprudence. Jefferson was well aware that imprudence in the use of public monies led to unintended consequences -— the bane of good governance. When an exasperated Nancy Pelosi told a reporter in a response to a question of what exactly was in Obamacare, “We have to pass the bill so you can find out what is in it,” the speaker of the House was not making idle chatter. She was dead serious, and to this day, we still haven’t grasped the enormity of what Congress has wrought in “reforming” health insurance and the health care industry. Certainly one of those consequences is forcing people to see physician’s aides and nurses rather than MDs because there simply aren’t enough doctors.

It should also be noted that many opponents of Obamacare warned of just such a physician shortage prior to passage of the bill. It’s not like liberals were unaware of some of the consequences in passing Obamacare. It’s that they didn’t care. “Making history” was more important.

Prior to the passage of Obamacare, supporters of the bill were quite fond of quoting a Harvard study about how 45,000 lives were being lost every year because people were uninsured.

I wonder how many lives will be lost because of undiagnosed ailments due to incompetent care, or long waiting times to see a physician, or unforeseen — and unintended — fallout from passing this wildly imprudent piece of legislation.

Harvard is never around when you need them.