There aren't enough doctors to make Obamacare work

Obamacare supporters claim that giving everyone insurance will reduce the use of the emergency room at the local hospital and there will be a huge cost savings. This seems on the surface to be a logical argument. Going to a primary care physician is a lot cheaper than the hospital emergency department. Will this change actually save money on emergency hospital visits? Let's examine Massachusetts which enacted legislation the in 2006 that much of Obamacare is modeled after. Massachusetts has a 97% insurance coverage rate and the highest highest concentration of doctors in the US. Strangely, emergency room visits have increased by 7% since insurance coverage was dramatically increased in Massachusetts. Why is this? Even though Massachusetts has the highest concentration of doctors nationwide, there aren't enough to cover the influx of new patients. Wait times have dramatically increased. If Obamacare is passed, this doctor shortage will be worse in the rest of the country. Long waiting lines are a form of rationing.

From CNN:

(CNN) -- When President Obama recently cited the number of Americans without health insurance, he declared that, "We are not a nation that accepts nearly 46 million uninsured men, women, and children."

Uninsured patients often delay preventive care, waiting to seek medical attention only when their conditions worsen. This leads to more intensive treatment, often in the emergency department or hospital where costs run the highest.

Universal health coverage is therefore a sensible goal, and the reforms being considered all make considerable effort to provide everyone with affordable health care.

But expanding coverage cannot succeed as long as there remains a shortage of primary care clinicians.

After all, what good is having health insurance if you can't find a doctor to see you?

Massachusetts is often held out as a model for national health reform, and the bills being considered in Washington emulate much of that state's 2006 landmark universal coverage law. As a physician in neighboring New Hampshire, I have had the opportunity to observe the effect of the Massachusetts reforms.

Today, 97 percent of Massachusetts residents have health insurance, the highest in the country. But less publicized are the unintended consequences that the influx of half a million newly insured patients has had on an unprepared primary care system.

The Massachusetts Medical Society reported that the average wait time for a new patient looking for a primary care doctor ranged from 36 to 50 days, with almost half of internal medicine physicians closing their doors entirely to new patients. And when you consider that Massachusetts already has the highest concentration of doctors nationwide, wait times will likely be worse in other, less physician-abundant parts of the country, should universal coverage be enacted federally.

When patients are forced to wait weeks to obtain medical care, they inevitably find their way into the emergency department for treatment that ordinarily can be handled in a doctor's office. Indeed, since health reform was passed, according to state data provided to the Boston Globe, Massachusetts emergency rooms have reported a 7 percent increase in volume, which markedly inflates costs when you consider that emergency room treatment can be up to 10 times more expensive than an office visit for the same ailment.

Wondering what Obama's national health care will look like? Then check out Boston, where the wait for a doctor can be more than a year

National health insurance may flood the system with new patients. This may cause very long delays in your ability to schedule an appointment at many doctor's offices. Boston.com is reporting:

Despite Boston's abundance of top-notch medical specialists, the waits to see dermatologists, obstetrician-gynecologists, and orthopedic surgeons for routine care have grown longer - to as much as a year for the busiest doctors.

A study of five specialties shows that the wait for a nonurgent appointment in the Boston area has increased in the past five years, and now averages 50 days - more than three weeks longer than in any other city studied.

Patients in Boston and other areas of Massachusetts for years have faced notoriously long delays, according to earlier surveys of physicians' offices. A number of factors contribute, doctors said, but the 2006 health insurance law, which has required hundreds of thousands of state residents to obtain coverage, probably has worsened the waits.

"We had a bus that was pretty full, and then we invited more people on the bus," said Dr. Gene Lindsey, president of Harvard Vanguard Medical Associates, a large physicians group. "Now people are standing in the aisles."

Merritt, Hawkins & Associates, a Texas-based consulting and physician recruiting firm, surveyed 1,162 doctors' offices in 15 metropolitan areas, trying to replicate what new patients would experience if they were searching for a doctor for a nonurgent appointment, including a heart checkup, a skin exam to detect possible cancer, knee injury or pain, a gynecological exam, and a complete physical exam.

Boston had the longest delays to see dermatologists, obstetrician-gynecologists, and family practitioners, and was second after Dallas in delays to see orthopedic surgeons. Waits increased since 2004 for appointments with dermatologists, obstetrician-gynecologists, and orthopedic surgeons, but patients can get in faster now to see cardiologists; Boston ranked fourth in waits for heart doctors, behind Minneapolis, Miami, and San Diego. The company did not survey family practitioners in 2004.

Average times to get appointments with doctors in Boston ranged from 21 days for cardiologists to 70 days for obstetrician-gynecologists. But when surveyers called, some dermatology and family practice offices said they couldn't get an appointment for a year.

The survey did not address whether delays hurt patients, or why Boston is generally worse than other cities.

But the authors also pointed to the more than 400,000 newly insured residents flooding doctors' offices, and said the long waits in Boston "may signal what could happen nationally in the event that access to healthcare is expanded through healthcare reform.