Wednesday, July 15, 2009

Health Care Access vs. Health Care Coverage

According to, "House Speaker Nancy Pelosi and top Democrats opened an all-fronts charge Tuesday to pass a $1 trillion, 10-year health care overhaul by August, unveiling legislation that would tax the wealthy to pay for universal coverage, create a public insurance plan and require individuals to carry insurance and businesses to offer it."

They hope to pass this bill in the next 15 days (counting the weekends).

The story seems to be that, without health insurance, there is no access to health care. That is not quite true. Hospital Emergency Rooms must treat patients regardless of their ability to pay. And, as Ed Morrissey over at Hot Air pointed out, just because the Government says they'll take care of your medical needs, doesn't mean you have access to a doctor or a hospital.

Without doctors, nurse practitioners, nurses, physician assistants, technicians, pharmacists, therapists, and some health-related jobs I'm forgetting, no one has access to health care. The population of the U.S. is growing in real numbers and demographically is getting older--which means increasing demand. Is the supply keeping up?

Curious, I looked at medical schools and found this report on enrollment, just released by the Association of American Medical Colleges. There are currently 130 medical schools in the U.S. According to the opening paragraph of the report:

"Each year, the AAMC Center for Workforce Studies surveys medical schools regarding their enrollment plans for the next 5 years. Based on the 2008 survey, the AAMC estimates that first-year U.S. medical school enrollment will increase to 19,946 in the 2013 academic year. This represents an increase of 21% (3,458) from the 2002 academic year. Looking beyond 2013, this rate of growth will not lead to a 30% increase by 2015 as recommended by AAMC, but it could by 2017 or 2018."

Medical schools are targeting minority and rural students, hoping they will practice in underserved communities. The report does not clarify how it arrived at the 30% figure, whether that takes into account the drop-out rate of medical students during their four years of study, the rate of retirement of doctors currently practicing, population growth, or other factors.

The target figure is jeopardized primarily by the lack of financial resources in public schools to expand their classrooms, labs, and faculty; by the cost borne by the medical students; and by a shortage of training clinics. The shortage of clinics is critical: that's where medical students and interns practice, under supervision. Some of these clinics also contract with foreign medical schools, further limiting spaces.

This report is discussing only doctors. Anecdotal evidence (children of friends who want to go into nursing and family members in related health fields) suggests that the problem is worse for other health professions.

So, taking a supply-and-demand approach to this, if we are serious about increasing access to health care, shouldn't we concentrate on increasing the number of providers? And, if the number of providers increases, wouldn't the cost decrease because of competition?

Seems to me that the experience of Canada and the NHS in Britain bear this out. There is universal coverage; access, however, is determined by where you live--how much money your Province or County has in their budget. And, frankly, how is that so different than what happens in the U.S.? Where you live is almost more important than whether or not you have insurance to pay for your care.