Sound-bite this!

John Taylor: August 24, 20070 Comments

The question's not that difficult, and the answer is simple. Simply painful.


At some presidential or gubernatorial debate this needs to be asked: "If you've got a plan to provide health insurance coverage to most everybody, what's your plan to ensure there are enough doctors and hospital beds to treat most everybody?"


Unless I've been watching too many "Got milk?" commercials, the only possible answer is -- we can ensure coverage, but we can't guarantee access to care.


Used to be if you had insurance, somebody with a medical degree would be willing to treat you. But now the insured are experiencing the same frustrations as the uninsured.


The Wall Street Journal reported that in Massachusetts, which recently implemented a state-subsidized, insurance-for-all law, the average wait to get an appointment with a primary care doc is --- seven weeks. That's if one will take you. At Boston's top three teaching hospitals, the story says, 95% of their 270 primary care docs aren't enrolling new patients. And neither are 49% of the state's internists.


The reason -- which is also accompanied by a national decline in the number of third-year medical students who want to do primary care work -- is too much work for too little cash. Specialists make more, and some have actual dinners with their families.


When it comes to specialists seeing the uninsured, the Los Angeles Times reports that with the downsizing of oft-troubled Martin Luther King Jr-Harbor Hospital, the wait for gallbladder or hernia surgery is as long as a year.  The backlog means patients at one clinic can wait six months to get a letter scheduling an appointment for surgery and another two months before the appointment occurs.


"Waiting" is a relative term, kind of like "on time arrival" at airports. The Press Ganey research firm did a survey of 1.5 million patients to gauge how long they waited in specialty physicians' offices before they were seen. The longest wait was 31 minutes for an orthopedist and the shortest was 20 minutes for a dermatologist.


Don't know all the survey specifics, but wonder if the "waiting" ended when an office assistant took patients to a treatment room or for an X-ray. Of course, the actual face time with a specialist usually goes as fast as a buzz-cut.


How do you educate/sustain more docs? How do you prevent hospitals with jam-packed emergency rooms from closing, the only places where people are guaranteed access irrespective of insurance?


How big an issue is it? If you Google "health care reform," you get about 52.7 million hits; if you plug in "health care access," the total soars to 255 million. Of course, that's not scientific, nor does it settle anything. Neither do candidates who bandy about universal coverage as though it were a winning lottery number.