Health Care: Unintended Consequences?

A lot of the debate on a new health care system is based on costs. But what's the impact of 40 million new customers on the system's ability to deliver services? First, a lot shorter wait in the ER as uninsured patients learn to stop using the ER for anything that comes up. But where do those people go, and what happens to their resource usage? The way our health care delivery system is structured, they would go first to primary care providers. Of course, these are the people being most economically squeezed by the current system, and it seems that there's already a bit of a squeeze--that many doctors have decided to become specialists for financial and lifestyle considerations.

If 40 million new customers spent an hour per year with a primary care provider, that would require about 20,000 more primary care providers. Looking at 2006 data on physicians, it looked to me as if there are about 300,000 doctors who could fill this demand. So the new demand would require about a 7% increase in the number of doctors devoted to this service. Since it's plausible that the uninsured have a backlog of unmet preventive care needs, and possibly a greater need for consumer education, time demands could be greater. It's interesting that Massachusetts, which requires health care coverage of its citizens, is also the state with the largest number of doctors relative to the population. There are many states with substantially fewer doctors per capita. Their resources may be more fully utilized. Anecdotally, many of us have experience with primary care physicians who aren't taking new patients.

Complex legislation almost always has unintended consequences. This may be one of them.