Saturday, July 26, 2014
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Ponder this as you wait for your doctor

Last year's health-care overhaul created an expert commission to look for solutions to America's chronic shortage of primary-care doctors. Without funding, it can't start addressing the problem.

Ponder this as you wait for your doctor

One health-care concern that predates last year's Affordable Care Act is the country's chronic  shortage of primary-care physicians. So it's worth wondering why congressional Republicans are blocking a small provision of the law designed to help address that problem - "an influential commission to guide the country in matching the supply of health-care workers with the need," as Amy Goldstein describes it in the Washington Post.

Goldstein reports that nothing has happened in the eight months since the commission's members were named:

The group cannot convene, converse or hire staff because $3 million that it needs for its initial year has been blocked by two partisan wars on Capitol Hill — strife over the federal budget and Republicans’ disdain for the health-care changes that Democrats muscled into law 14 months ago.

“We’ve been sort of hamstrung,” said Fitzhugh Mullan, a professor of medicine and health policy at George Washington University who is one of the 15 commission members appointed by the Government Accountability Office. The panel’s only activity so far, Mullan said, was a single conference call during which members were told they could not lobby members of Congress for funds or accept money to operate from foundations or anywhere else.

The National Health Care Workforce Commission is intended as an ongoing brain trust to focus new energy on solving an old problem that will become increasingly severe. The law says the new commission will analyze primary-care shortages and propose innovations for the government — and medical schools — to help produce the doctors and other health workers the nation needs. The idea is to furnish expertise to counterbalance the intense lobbying of medical groups.

The commission is unlike many other aspects of the law, which have built-in money to carry them out. Despite the efforts of some Democratic senators, appropriations for the commission were not in the continuing budget resolution Congress belatedly adopted for the fiscal year that began last fall. President Obama has requested the $3 million in his budget proposal for next year, but Republicans who control the House oppose it.

Jonathan Cohn, who blogs for the Kaiser Family Foundation and the New Republic's website, says the ACA also tries to address the problem by raising reimbursements for primary-care providers, "bringing their potential incomes closer (although not close enough) to those of specialists."

But Cohn calls it hypocrisy for Republicans to block the commission's work even as they complain about wait times in Massachusetts under Romneycare and try to blame them on increased access to health care. Cohn has previously skewered that argument with data showing that long waits preceded the 2007 Massachusetts reform - you can find his earlier post on that subject by clicking here: Defending Romneycare (Because Romney Won't Do It). (You can also see, above, one of the trend charts that Cohn provides.)

Long waits for doctors, and educational and reimbursement structures that may encourage the training of too many specialists and too few primary-care providers, are long-term problems in American medicine.  The commission is a modest attempt to move forward toward finding solutions.  Why does everything in Washington have to get swallowed up in partisan fights?

Jeff Gelles Inquirer Business Columnist
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Jeff Gelles Inquirer Business Columnist
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