Catastrophe - Dick Morris [46]
President Obama is right to complain about the high cost of health care, which now consumes 16 percent of our GDP. When Bill Clinton urged reform in 1993, it ate up 12 percent of the GDP—and he warned of disaster if it rose to 14 percent.
But Obama hasn’t explained how he’s going to cover 47 million more people and reduce the cost of health care at the same time.
Let us do the honors.
He won’t tell you this, but the silent centerpiece of Obama’s program is his plan to ration health care, giving it to some and denying it to others.
The bad news is, rationing health care is the only thing that makes his program possible.
You can’t expand medical care just by spending more money. It has to be delivered by a special group of people—doctors and nurses. And there just aren’t enough to go around. We barely have enough to offer health care services as it is. To stretch them even thinner—thin enough to cover 47 million more people—would be impossible.
As the Wall Street Journal notes, Obama’s “focus only on extending health-care coverage ignores the serious shortage of primary-care physicians. Physicians are increasingly going into specialties and the ranks of generalists, the essential first line diagnosticians and caregivers, are shrinking. Without more physicians, those receiving the extended insurance will not be able to find health-care providers.”154
Though the number of doctors in the United States rose sharply in the past decades, it has actually been leveling off, with only a slight increase, in recent years. The increase in the doctor population averages about 1 percent per year, not even enough even to keep up with U.S. population growth. And certainly not enough to care for a 20 percent increase in their workload—as projected by Obama’s plan to cover 47 million new people.
The nurse population, meanwhile, has not risen at all. In a March 2008 report, Dr. Peter Buerhaus of the Vanderbilt University School of Nursing predicted that the shortage of registered nurses in the United States could reach as high as 500,000 by 2025.155
If doctors and nurses can barely meet the needs of the 253 million Americans who have insurance or government coverage, how will they deal with the unmet medical needs of the 47 million uninsured Americans whom Obama plans to cover? Where are all those doctors and nurses going to come from?
According to classical economics, when too many people want a service and there are too few professionals to deliver it, the price rises and those who can afford care get it; those who can’t are left out.
That’s what liberals say is happening today. Those who are fortunate enough to have insurance, either through the workplace or through government programs, get the care they need and the others miss out.
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ACTIVE PHYSICIANS AND NURSES IN THE UNITED STATES
Physicians
2006 800, 586
2005 790, 128
2004 780, 662
2003 774, 849
Nurses
2006 2, 421, 000
2005 2, 417, 150
Source: Statistical Abstract of the United States.
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If you are over sixty-five, you’re eligible for Medicare and most of your health care costs are covered. If you are poor, you are entitled to Medicaid, with similarly extensive coverage. If your employer is enrolled in an insurance plan, you’re covered as well. If you’re a child whose parents earn too much for Medicaid but less than about $50,000 a year, you can get coverage through the State Child Health Insurance Program (SCHIP).
All told, 70 percent of Americans with health coverage get it through their employers.156 But 47 million don’t have coverage.
Who are the uninsured?
Around one-quarter are eligible for Medicaid but haven’t applied. They generally aren’t sick. When they need care, they enroll in Medicaid and get it.
Another sixth are illegal immigrants. Although Obama says he won’t cover them, he will speed their path to legal status and thus to coverage.
Who are the rest? They are mainly working-age adults who are not impoverished but don’t have coverage through their jobs.