A fundamental flaw

Make that another fundamental flaw

Monday, December 2, 2013

YOU’RE at your doctor’s office at the agreed-upon time. You smile at the receptionist, sign in, and have a seat. Maybe you’ll be called back to the desk a few minutes later to take care of your co-pay. Nice to see you again today, Mrs. Patient. Is this just a check-up? Oh, that darned muscle cramp again? We’ll get you back to the doctor as soon as we can.

And you sit down and read the paper.

The crossword puzzle is hard today.

That crazy Wally Hall.

Why are the letter-writers so upset about the colors of jerseys on a football team?

You finish the paper. And wait.

And wait. Every five to 10 minutes, somebody’s name is called, and he goes back to see the doctor.

And you wait some more.

This can go on for 45 minutes, maybe an hour, maybe longer. But you finally hear your name, you pop up, the nurse escorts you to a waiting room, and you’re told to have a seat because “the doctor will see you soon.”

And you wait some more.

Soon you’re digging through the pile of children’s books in the office’s bin for want of anything else to read. Ooh, an issue of Highlights!

THIS is what a lot of Americans are experiencing at the doctor’s office even before the tongue depressor goes into our mouths. It’s not the doctor’s fault. He doesn’t like it any better than you do. It’s not his scheduler’s fault. It’s how things happen these days. Most folks have accepted it as part of our lives, the way we used to put aside an hour or two, or a whole day, for what should have been just a simple trip to the DMV. Remember the years before Mike Huckabee reformed the system? (And we’ll always be grateful, Rev./Gov.)

Back in ought-nine, when the president, Congress and the country began debating the Affordable Care Act, aka Obamacare, some of us weren’t above asking simple questions. For example: Who’s going to make all this work?

The purpose of Obamacare was to give millions more Americans access to health-care coverage. And all those new patients were going to get access to the insurance that would pay for it, too, even if the taxpayers would have to chip in.

All this was supposed to put millions more of us on Medicaid-those men, women and children who live with low incomes. Specifically, up to 138 percent of the poverty level. Young adults would be able to stay on their parents’ insurance until they turned 26. Many of them had always just taken a chance and skipped insurance and regular doctor visits.

Now all these new insurance policies were to be ginned up, too, so they covered essential care. Correction:what the federal government decided was essential care-from abortions to treatment for erectile dysfunction.

But . . . .

Obamacare didn’t, and won’t, create one new doctor. So the question remains: Who’s going to do all the work? Answers are rare.

The question exposes a fundamental flaw in what’s formally titled the Affordable Care Act. If health care is affordable but unavailable, or your wait time is so long that a visit to your doctor doesn’t seem worth it, how is Obamacare an improvement? Health care that’s unavailable might as well be unaffordable.

LAST WEEK the New York Times wrote about the mounting pressures on those doctors who still accept Medicaid patients. The short version: Medicaid has struggled for years

with a shortage of doctors willing to

(1) take what Medicaid pays them, and (2) also deal with Medicaid’s red tape. Which means that many patients have had to wait for health care. Maybe for years. Now they’ll get to wait some more.

Millions more Americans are now due to go on Medicaid. According to the Congressional Budget Office, nine (9) million more Americans. In the next year alone.

Community clinics, according to the report in the Times, are having to expand and hire more medical staff. If they can just find enough bodies.

Nurses are wonderful people. And so are physicians’ assistants and medical orderlies. There’s got to be a special place in heaven for all of them. But they aren’t doctors.

Now more doctors are being hired by managed-care companies. But those doctors, and the ones graduating from medical schools this year, were going to be practicing anyway. And we repeat, Obamacare doesn’t create one additional doctor.

California, the state featured in the Times story, has the largest number of people on Medicaid in the country, and officials there said they are “confident that access will not be an issue.” As confident as the feds were about how successful Obamacare was going to be before it was rolled out? Or rather not rolled out very well. The doctors quoted in the Times story-those who are going to have to do the work-disagreed with these oh-so-confident but unnamed officials.

Which leaves the same old question still unanswered: Who’s going to do all the work?

Something tells us that the flaws in Obamacare are only beginning to surface-a bunch of them this week, another bunch next week, and after that . . . .

Get ready, America. And schedule your 2014 doctor visits now.

Editorial, Pages 12 on 12/02/2013