Obama’s Health Plan & the Physician Shortage

Healthcare costs continue to skyrocket and 47 million Americans are without health insurance. President-elect Barack Obama’s health care plan is “to provide affordable, accessible health care to all.” Obama recently named Tom Daschle secretary of health and human services. The posting Review of the CBO’s Annual Report to Congress highlighted raising health care costs as one of the primary drivers of the US Government’s budget deficit in the coming decade. Much of Obama’s plan is focused on the affordability aspects of healthcare, with limited emphasis on the accessibility of health care. A universal health care system may provide insurance to the millions of uninsured, but it will not provide doctors for the uninsured. Massachusetts health care reform has provided insurance to many previously uninsured, but the plan has not provided physicians to the newly insured.

The aging US population is driving a need for an increase in primary care professionals; unfortunately, the number primary care professionals has been declining at dramatic rates over the past decade. The American Medical Association (AMA) predicted a shortage of 35,000 to 40,000 primary care physicians at its 2008 annual meeting. The AMA has three primary tools to mitigate the physician shortage, (1) debt forgiveness, (2) recruitment and training, and (3) increased insurance reimbursement rates. Increased pay via debt forgiveness and reimbursement would certainly help bridge the gap in salaries between primary care and specialists, but a recent CNN article Half of primary-care doctors in survey would leave medicine reports that red tape with insurance companies and government agencies as well as malpractice insurance are the reasons physicians are considering leaving the industry. Additionally, physicians are closing their practices to Medicare and Medicaid patients, one-third and 12% of physicians respectively – highlighting the lack of available health care for Americans.

Obama’s plan is focused on reducing the cost side of health care, primarily through improved information technology infrastructure and increased competition among insurers, theoretically reducing premiums. The plan does touch on the health care workforce as an important component of the plan. His vague solutions include loan repayment, adequate reimbursement, training, and infrastructure support. The IT infrastructure should be a positive step to reducing the ‘red tape’ associated with reimbursements and anti-competitive measures in malpractice should help reduce the costs for primary care physicians. Daschle would like to create the Federal Health Board to set guidelines for cost-effective treatments.

Suggested Policy Reform
Malpractice – The best way to reduce the cost of malpractice insurance is to reduce the outflows for insurance companies. Reduce malpractices instances – increased professionals and appropriate reimbursement rates should reduce the workload for physicians, increasing the time with patients there by reducing the number errors. Malpractice insurance has roughly kept pace with overall health care costs and a Dartmouth study found that lack of financial returns has strained insurers, not huge settlements.

Loan Forgiveness – The US government should provide tax credits to hospitals and clinics that provide loan forgiveness to primary care professionals. Professionals should earn their loan forgiveness through years of service with the organization.

Reimbursement Rates – Insurance and government reimbursement rates should be with respect to cost of care, including time spent with the patient, not based on delivery of specific treatments. More equitable reimbursement rates should help with physician compensation and hopefully the number of medical students choosing primary care.