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Having Your Cake and Eating It Too

Have you ever wondered how anyone could possibly think that the Patient Protection and Affordable Care Act (PPACA) would lead to less health care spending?

Consider that the act is expected to (a) insure more than half the uninsured, (b) push most people with private insurance into more generous plans and (c) give just about everyone more generous preventive care. Doesn’t more insurance always mean more spending?

A big part of the answer is a little known change in PPACA on its way to final passage. In an obvious effort to keep the bill’s cost under control, lawmakers zeroed out all the funding for new doctors, nurses and other paramedical personnel. It doesn’t matter what extra benefits are promised if there is no one to deliver on the promises! Hence, the CBO’s low-ball spending estimate.

The problem is that groups with a special interest in health care — particularly the elderly and the disabled — noticed this sleight of hand and became alarmed. With a severe doctor shortage in the making, if your plan pays well below market rates you’re at risk of being pushed to the end of the waiting lines. And this has created a political hot potato for the White House.

The Obama administration picked up on this problem quickly. Ever since the passage of PPACA, it has been going to great lengths to assure anyone who would listen that it was leaving no stone unturned in an effort to create more medical providers — with or without the approval of Congress.

But hold on! You can’t both give people tons of extra health care and at the same time claim you’re holding down costs. It’s A or non-A, but not both. If the administration succeeds in creating more doctors, more health care spending is inevitable. My guess is we will be somewhere in between. We’re going to get some more providers; they are going to deliver more care; and spending will go up as a result. But we are not going to increase supply enough to prevent substantial shortages — much worse than we have today.

If government estimates are correct, as many as 34 million uninsured people will acquire health insurance. If economic studies are correct, these 34 million people will try to double their consumption of health care. In addition, another 70 million people or so are likely to acquire health insurance substantially more generous than what they have today. Moreover, most of the remaining 200 million people will be entitled to preventive services without copayments and deductibles they pay today. They are going to expect annual physicals, mammograms, Pap smears, prostate cancer (PSA) tests, colonoscopies and other services they -are not currently getting.

How can this increased demand possibly be satisfied? More than one in five Americans already lives in an under-doctored area. Moreover, a Duke University study implies that if all Americans get all the free preventive care promised them under the Affordable Care Act, family doctors will have to spend all their time on these tasks alone — leaving no time left over for all of the other things doctors do.

In response to this problem, a government Web site claims there will be 16,000 new providers by 2015. Yet Congress has never appropriated the funds to do that.

Apparently, Health and Human Services Secretary Kathleen Sebelius plans to use $250 million targeted for “prevention and public health” in the PPACA to instead train 500 physicians, 600 physician assistants and 600 nurse practitioners. Also, she plans to use an additional $500 million of “stimulus” money available under the American Recovery and Investment Act. Yet even if Congress allows these decisions to go forward, the additional supply will still fall way short of the 16,000 figure (which appears to count students who are already in medical school and will largely replace doctors who are expected to retire).

Meanwhile, the Association of American Medical Colleges predicts a 21,000 primary care physician shortfall by 2015. The Health Resources and Services Administration estimates a short of between 55,000 and 150,000 physicians by 2020 — and that was before health care reform passed! The state of Texas is predicting a nurse shortage of 18,000 by 2015 in that state alone.

John C. Goodman, PhD, is president and CEO of the National Center for Policy Analysis.  He is also the Kellye Wright Fellow in health care. The mission of the Wright Fellowship is to promote a more patient-centered, consumer-driven health care system. Dr. Goodman’s Health Policy Blog is considered among the top conservative health care blogs on the internet where pro-free enterprise, private sector solutions to health care problems are discussed by top health policy experts from all sides of the political spectrum.

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Darrellinchoate but earnestTimNateJ.S. Recent comment authors
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Darrell
Guest

It’s going to be end of mine day, however before end I am reading this impressive piece of writing
to increase my knowledge.

Look at my web-site; g pen vapor trial (Darrell)

J.S.
Guest
J.S.

“But what are you for?”
REPEAL Mess-iah’s mess
REFORM based on REALITY
REPAIR
Of 279 U.S. House members who voted for “health care deform” —
NONE are using “health care deform” in their campaign materials.
None. Zero. Nada. Zip.
Many of those SAPS are NO longer taking calls from the White House. A depression is when you lose your job, good buddies.
“Heck’a job, OweBama.”
This is done. Nov. 2, Mess-iah’s mess gets cleaned up. And a lot of deadwood in Congress gets unemployed.

inchoate but earnest
Guest
inchoate but earnest

Thanks for your helpful insights js, but really you shouldn’t have wasted your, or our, time with your uninformed, information-free whining. We get it – you’re agin‘ something.
But what are you for?
And if you bleat something like “free markets”, I’m gonna give you such a pinch….

J.S.
Guest
J.S.

JUST BULL
“At ~ 7:30 ET 9/9, there’s as yet no sign of the new cost report from Medicare’s actuary ..”
BFD. There are a zillion reports, saying a zillion different things. CBO’s original Medicare estimate is now 800% BIGGER than original. And two years ago, Bwarney Fwrank and Pelosi said Fannie/Freddie was fine.
No one with a brain believes a word from the Chicago Mob. They’re just trying to keep their losses to below 35 U.S. House seats.
A cynical view, from a cynical time.

inchoate but earnest
Guest
inchoate but earnest
ExhaustedMD
Guest
ExhaustedMD

Decided to respond to Peter’s retort from yesterday regarding campaign finance reform and voting third party: Well, we saw what happened with campaign finance reform, thanks loads from the loaded Supremes down the street from the Capitol, and I have been voting third party since I “earned” voting rights (by turning 18, but what is a number?), except the one stupid time I voted for Clinton’s first term, as I could not vote for Perot as crazy is as crazy does. But, we all make mistakes, right? The issue is incumbency, but, this one party system of Republocrats won’t let… Read more »

inchoate but earnest
Guest
inchoate but earnest

We have to admit, we were frankly stumped why Dr. Goodman would link to a Health Affairs report from 2003 – one that essentially dismisses his breathless alarm at the cost of providing access to all those uninsured – in his original post. That report concludes that, despite “34 million people [trying] to double their consumption of health care”, the cost would raise US health care’s share of GDP about 1 percentage point. But now we get it: Dr. Goodman was probably just trying to get out ahead of a new cost report to be issued today by Medicare’s chief… Read more »

J.S.
Guest
J.S.

” .. By the way, single-pay is the only system that will rescue this healthcare system from it’s own greed and economic abyss and I’m disappointed you hold those who see this in the same light as the likes of the J.S. crowd ..” Sure, pal. And Fannie/Freddie (the “single-payer” of finance) and Bwarney Fwrank did not create the Great Depression II. So, let’s go for Great Depression III, with “single-payer.” I’m disappointed in you and your ad-hom attacks. Well, life will go on. See you on Nov. 2 at the ballot box. P.S.: did you hear? OweBama threw S-P… Read more »

Peter
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Peter

“If not, we’ll at least stop hearing from the “remember in November” crowd and the “we must have single payer” contingent. I can’t wait.”
I guess Paolo you think the “reasoned” moderate third leg of voters will be enough to save Democrats from themselves? By the way, single-pay is the only system that will rescue this healthcare system from it’s own greed and economic abyss and I’m disappointed you hold those who see this in the same light as the likes of the J.S. crowd.

Paolo
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Paolo

November 3rd can’t come fast enough. Maybe the GOP will be able to push through some tort reform, defund the death panels, prohibit health benefits for illegals, strip out the public option, undo the government takeover, close down the IRS jails, call this “repeal and replace”, and finally declare victory. And then we’ll all live happily ever after.
If not, we’ll at least stop hearing from the “remember in November” crowd and the “we must have single payer” contingent. I can’t wait.

J.S.
Guest
J.S.

A bloody Harvard Law incompetent pushed into a legal cesspool — and now there’s push-back. Boarding on chaos.
Hope! Change! Incompetence! Chaos!
NO JOBS!
Whine all you want — Nov. 2 is the castor oil. Get used to it — or get out. Could care less, about your whine.

Peter
Guest
Peter

Republicans always seem to be Republicans – they’re usually wrong but no taxes, no regulation seems to work every time with voters who have short memories.
“Entrenched selfish bastards who don’t give a fecal impaction about you and I in the end. Unless, you’re a special interest?”
Then push and vote for campaign finance reform. It’s always the money. You could also vote Libertarian.

ExhaustedMD
Guest
ExhaustedMD

Hmm, Peter, could replace the word Democrat with Republican and the first sentence wouldn’t change at all in meaning.
Incumbents are cowards and whores, and that is why if you want real change and real representation, vote any and all in office more than 10-15 years OUT on the 2nd of November! Pelosi and Reid are interchangeable for Boehner and McConnell. Entrenched selfish bastards who don’t give a fecal impaction about you and I in the end.
Unless, you’re a special interest?

Peter
Guest
Peter

“Just read this morning this little tidbit: of the 279 Democrats in the House and Senate who voted to approve Obamination Care, NOT ONE is using their vote in their campaign ads.”
Democrats are cowards who can’t decide when they should be Democrats and when they should look like Republicans. That’s why many Dems won’t bother to vote this time, it’s hard to tell which Democrat they’re voting for.

Tim
Guest
Tim

So John Goodman writes a post from the right, and Matthew Holt from the left chimes in to say that John in his diabolical conservatism left out — as usual — a major part of the picture. And what is that key factor, that trump card the twicky wabbit conservative hid behind his back to once again scam the audience?
Drum roll.
“Waste.”