Washblog

This is the situation that Massachusetts finds itself in and is realizing that universal coverage is no panacea in a health care system that remains broken.  A recent story in the Boston Globe by Liz Kowalcyzk (Sept 22) spells out how wait times to get in to see a primary care physician has dramatically increased to as long as 100 days since reforms were enacted there that has led to a population being 94.6% insured.   Once the riddle of coverage is solved the issue of access is going to remain.

There are two issues of access here.  The first is that there needs to be enough bodies.  According to the Health Resources and Services Administration every county in Washington State has primary care shortage areas and nearly half of the counties, including here in Grays Harbor, the entire county carries the official designation.  If Washington State ever achieves universal or near universal coverage, we will encounter longer wait times like Massachusetts.

Between lower salaries for primary care physicians and biases toward subspecialist medicine in academic medical centers, medical schools are simply not producing enough primary care physicians.  The recent JAMA study showing only 2% of internal medicine residents planning on entering primary care only serves to reflect this.

The second issue of access is that the health insurance that people have must be of some value.  In many communities throughout Washington State and across the country, people with either Medicare or Medicaid cannot find a doctor.  They have insurance.  The problem is they cannot find anyone to take their insurance.  What are they left with?  The ER just like the uninsured.

Massachusetts has decided to expand the size of the University of Massachusetts Amherst Medical School class and offer financial incentives such as loan repayment and various forms of housing subsidies to medical students who decide to go into primary care.  These measures will certainly help push those on the fence between sub-specialization and a generalists practice, but it does not not change the underlying problem.

As I've written before, it all comes back to what we value in our health care system.  In a logical and rational system do we value preventive medicine and management of chronic disease to prevent complications or do we value more the treatment of these complications?