I knew we forgot something

Time MachineMassachusetts’ carefully thought out plan to mandate health insurance for all its citizens left out one little detail: a time machine.  The Bay State’s would-be health care reformers could have used one to go back 10 or 20 years to warn the health care industry that inadequately reimbursing primary care would have consequences.  From the Kaiser Family Foundation:

Jacqueline Spain, medical director for Holyoke Health Center, said, “It’s entirely reasonable for somebody who’s now got insurance and maybe has a whole list of things that’s worried them and troubled them” to “expect that they should be able to go out in the market and get all of that care. There just aren’t enough [primary care physicians] to give it to them.” She said about 1,600 people currently are on the facility’s waiting list and patients must wait an average of four months to be seen.

Primary care doctors are leaving the field in part because insurers, Medicare and Medicaid pay less for primary care than for visits to specialists. Dan Levy, a physician who left primary care for medical administration, says the problem is being exacerbated as new patients arrive at PCPs with a long list of pent-up health concerns. He said, “You have someone on your hands with five separate medical problems, 15 minutes to see them. If you spend the extra half hour, you don’t get paid for it, so the pressure is to refer them to a subspecialist.”

According to NPR’s “All Things Considered,” the trend could raise health care costs, as people unable to see PCPs often visit emergency departments and let small medical problems grow into larger, more costly problems.

Yep, a time machine would be nice right about now.

Hat tip: InsureBlog
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