Why the Doctor Can't See You

NCPA August 16, 2012

Most provisions of the Obama health law (the Affordable Care Act, or ACA) kick in on Jan. 1, 2014. Within the decade after that, an additional 30 million people are expected to acquire health plans -- and if the economic studies are correct, they will try to double their use of the health care system. And once the ACA fully takes effect, all of us will be entitled to a long list of preventive services -- with no deductible or copayment, says John C. Goodman, president at the National Center for Policy Analysis, a research fellow at the Independent Institute, and author of Priceless: Curing the Healthcare Crisis.

Here is the problem: The health care system can't possibly deliver on the huge increase in demand for primary care services -- there aren't enough doctors.

When demand exceeds supply in a normal market, the price rises until it reaches a market-clearing level. But in this country, as in other developed nations, Americans do not primarily pay for care with their own money. They pay with time. As a result, the time it takes to get a doctor's appointment will rise.

·       For example, the average wait to see a new family doctor in this country is just under three weeks, according to a 2009 survey by medical consultancy Merritt Hawkins.

·       But in Boston, Mass. -- which enacted a law under Gov. Mitt Romney that established near-universal coverage -- the wait is about two months.

When demand exceeds supply, doctors have a great deal of flexibility about who they see and when they see them. Not surprisingly, they tend to see those patients first who pay the highest fees, such as those paying out-of-pocket for services like Botox.

Patients in plans that pay below-market prices (such as Medicare, Medicaid and likely those acquired in the ACA's health insurance exchanges) will likely wait longest, as a result. Their wait will only become longer as more and more Americans turn to concierge medicine for care. Concierge medicine basically means that patients pay doctors to be their agents, rather than the agents of third-party-payers such as insurance companies or government bureaucracies.

Here is the problem.

·       A typical primary care physician has about 2,500 patients, but when he opens a concierge practice, he'll typically take only about 500 patients with him.

·       The 2,000 patients left behind now must find another physician.

·       So in general, as concierge care grows, the strain on the rest of the system will become greater.

Goodman predicts that in the next several years concierge medicine will grow rapidly, and every senior who can afford one will have a concierge doctor. A lot of non-seniors will as well. We will quickly evolve into a two-tiered health care system, with those who can afford it getting more care and better care.

Source: John C. Goodman, "Why the Doctor Can't See You," August 14, 2012.