During the last couple of weeks, much has been made about the release of healthcare plans by the three leading Democratic presidential candidates. Each of the top tier candidates released significant plans to achieve "universal coverage" -- putative plans to provide coverage for the uninsured and the so-called under-insured.
For the most part, plans released by Sens. Hillary Clinton and Barack Obama and John Edwards are similar in purpose and in method. They involve some combination of the expanding the health program that covers Congressmen and an expansion of Medicare.
And they're absolutely on target when they say universal coverage is not only a moral imperative, but will help contain costs in the long run. But that only solves half of our monumental healthcare problem.
Because there's more to healthcare than just being able to pay for it -- if someone can't find a doctor, what's the use of having coverage?
Consider this: 24 percent of Medicare patients who are looking for a new primary care physician are already having difficulty finding one to begin with, according to MedPAC, the government commission that advises Congress on Medicare issues.
That means that a quarter of people who already have full coverage through Medicare -- somewhere around 11 million people -- can't use that coverage because they can't find a doctor in the first place. Let's assume that the presidential candidates' respective plans actually are able to provide coverage to the 47 million Americans who do not have it today. Where will they get treatment?
In other words, we've got ourselves a whole new doughnut hole: millions of Americans who have full healthcare coverage, but can't use it anywhere. With reimbursement rates in the basement, and medical students flocking to specialty care, the shortage in primary care physicians is growing to an unmanageable size. Even the insured can't find a doctor.
So (with all due respect to Huff Po-contributor Bill Maher) new rule: for every time presidential candidates bring up universal coverage, they must also talk about universal access. Because there's no point in universal coverage to pay for doctors that don't exist.
As it stands right now, we're not putting the cart before the horse, we're putting the cart without the horse. Yes, universal coverage is absolutely necessary. But unless we address the access problem, we'll mostly just be paying a lot more for the same amount of medical care. This is just how far backward our thinking has become when it comes to healthcare reform.
It's high time that our politicians realize that the healthcare crisis in this country is a two-part problem that requires a two-part solution. And they better start talking about it too.
Unfortunately, the presidential candidates haven't yet gotten the message that access, in the form of primary care doctors, plays an equal part of a two-pronged solution. In Barack Obama's healthcare plan, primary care appears once. Edwards' plan mentions primary care, but only while talking about coverage for preventive medicine. In Clinton's plan, primary care is nowhere to be found.
President Bush talked about access in Cleveland, Ohio this past July. "I mean, people have access to health care in America," the President said. "After all, you just go to an emergency room."
Given that kind of rhetoric, maybe we should be thankful that the Democrats are at least putting forward some comprehensive ideas to address 50 percent of our problem.
But to be clear, if any of the Democrats' plans go through without a correlating solution for access, the advice that President Bush gave will be the only available option to millions of Americans -- and that means far higher costs and far worse health results.
A lack of access is the reason healthcare costs are skyrocketing out of control. It's the reason we have record rates of chronic diseases like asthma and diabetes. And it's the reason we'll still have a healthcare crisis in this country, even if everyone has health insurance.
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Posted October 22, 2007 | 03:08 PM (EST)