Bryan Caplan  

Obamacare Shortages: Why Aren't We Going Sputnik?

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This is the most pessimistic prediction I've seen about how Obamacare will quickly lead to severe rationing of medical care:
The greatest threat to the health-care overhaul might not be the Supreme Court, which is scheduled to hear challenges to the law next month. Or the shifting alliances of an election year. In the end, it's more likely to be a lack of medical providers. If the law succeeds in extending health insurance to 32 million more Americans, there won't be enough doctors to see them. In fact, the anticipated shortfall of primary-care providers, by 2015, is staggering: 29,800.
The source: Sarah Kliff, writing on Ezra Klein's Washington Post blog.

If people were serious about making Obamacare work, I'd expect them to be "going Sputnik" - launching a national crusade to funnel far more smart kids into primary medicine.  I know why I'm against this idea, but why are normal people so apathetic about it?

HT: Tyler



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COMMENTS (11 to date)
Brian Moore writes:

Up until relatively recently, medical schools were being told that we were going to have too many doctors, and were artificially limiting supply.

Also, why would existing doctors, who lobby so hard against the "doc fix" because it would bite into their reimbursements (and I sympathize) get on board with a massive increase in the supply of their competitors?

It doesn't help that being a primary care physician (which is what we need, not more "doctors" in general) is a ridiculously punishing (and surprisingly unrewarding) profession.

Brian Moore writes:

One (old) article on the "limit doctors to prevent oversupply"

http://www.usatoday.com/news/health/2005-03-02-doctor-shortage_x.htm

Note the comments on how medicare funds residents.

"In 1997, to save money and prevent a doctor glut, Congress capped the number of residents that Medicare will pay [the hospitals at which they are residents] for at about 80,000 a year. "

I wonder how that affects the industry? The amount that medicare pays per year (last time I checked) was more than the average salary of those residents (which itself restricted by policy to a nationwide level, with some minor allowance for cost of living -- to prevent competition for residents).

Jared writes:

This may inadvertently put pressure on state legislatures to further deregulate the practices of advanced practice nurses, who are more than capable of addressing a great deal of primary care and also emergency care needs.

Charlie writes:

Seems like it would force us to revisit the policy of limiting the number of medical schools and also many of the restrictions that prevent NPs and PAs from giving more care. Might lead to some good outcomes.

Thomas Sewell writes:

National health care policy in the U.S. is incoherent. We have several different bureaucracies and NGOs working at direct opposites to each other.

Obamacare just makes the problem worse by pulling more decisions into the federal framework.

Ghost of Christmas Past writes:

The opinion leaders of the "ordinary people" aren't calling for more doctors because their own preceptors, committed to socialized medicine on the old Soviet model, have been telling them for years that doctors' greed is the root of medical-cost inflation and that training more doctors means higher costs, not lower. Since "higher costs" carries the parallel meaning of "less availability" (in bureaucratic terms, not free-market economic terms), vanguard party members are required to believe that training more doctors means having fewer doctors.*

As earlier commenters have pointed out, it is actually current government policy to restrict the supply of doctors. I think this policy results from a baptists & bootleggers coalition: doctors themselves dislike competition, and in the government's bureaucratic-leftist budgeting model (from which any notion of competition among providers is rigidly excluded) "more doctors" really does mean "more costs" (since each doctor will want one standard "polyclinic doctor" salary). For the bureaucrats there is the bonus that fewer doctors will have less political influence, both because of their (lack of) numbers and because smaller groups are easier to demonize (see the first paragraph).

*This contradiction does not embarass the vanguard. Consider Theodore Dalrymple:

Political correctness is communist propaganda writ small. In my study of communist societies, I came to the conclusion that the purpose of communist propaganda was not to persuade or convince, nor to inform, but to humiliate; and therefore, the less it corresponded to reality the better. When people are forced to remain silent when they are being told the most obvious lies, or even worse when they are forced to repeat the lies themselves, they lose once and for all their sense of probity. To assent to obvious lies is to co-operate with evil, and in some small way to become evil oneself. One's standing to resist anything is thus eroded, and even destroyed. A society of emasculated liars is easy to control. I think if you examine political correctness, it has the same effect and is intended to.
RPLong writes:

People who live in Canada have known about the doctor shortage for years. I've been screaming it from the rooftops ever since Obama was elected on the promise of ObamaCare, and nobody wants to listen.

I was an econ underclassman when my professors first showed me why increasing health care costs are a product of under-supply.

Nobody wants to listen to facts or evidence. The only thing that matters is society's collective fantasy that we can simply pass a law and all of our problems will be solved. How do you get through a mental block that large? How do you get people to start thinking about reality?

tom writes:

The Sputnik analogy doesn't work. A big effort to enourage/pay people to become low-paid primary care doctors would be more like urban teacher programs, which have been around forever. (Also, you need the shortage before you can push for the program so we'll have to wait five years.)

David C writes:

My guess would be most of the people who support the ACA and are smart enough to understand the issue believe broadening the base of people receiving care while reducing the amount of care for the average individual receiving it would be a good thing.

Vincent Davis writes:

I have been saying this for awhile, either shortage or price increase you choose. Wha scares me is that I think it will be difficult to buy care. By that I mean if I am willing to pay cash and "over" pay I am not sure I will be allowed to.

Issac Maez writes:

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