December 12, 2013 | Posted By Bruce White, DO, JD

A July 28, 2012 article in The New York Times by Anne Lowry and Robert Pear titled “Doctor Shortage Likely to Worsen with Health Law” was recently updated with a follow-up report about Medicaid expansion by Abby Goodnough in a piece titled “Medicaid Growth Could Aggravate Doctor Shortage.” 

Many report that there’s not enough doctors now. It may be curious and rhetorical, but why would anyone suspect that there’s not going to be doctor shortages of some degree – in the very near future – if Medicaid expands by 9 million new persons and the Affordable Care Act (ACA) adds another 30 million or so newly-insured patients to those already covered by some plan. How could this not have been anticipated? It must have been factored into the ACA equation. In the same way that legislators should have realized that some insured would not be able to “keep their coverage” once the new health law was to take effect.

Neither the resulting doctor shortage nor the insurance policy changes are unintended or unexpected consequences of the ACA. It’s unimaginable that these possibilities were not considered in some detail. As late as a few months ago, the Congressional Budget Office predicted that health care costs would clearly rise over time because of the new enrollments in Medicaid and the ACA contrary to what some politicians say about the ACA decreasing or “controlling” health care costs.

Moreover, there are other changes that we should expect: (1) as the doctor shortage becomes more acute, we will probably see nurse practitioners’, physicians assistants’, and clinical pharmacists’ scopes expand to meet patient needs; (2) insurance companies will continually revise health insurance policy offerings to patients with premiums based on risk and availability of services; and (3) parents and grandparents will pay health insurance premiums for their children and grandchildren who cannot afford to pay the premiums themselves. These are all logical possibilities with Medicaid expansion and the ACA.

When talking about free trade, economists often raise the point of  “creative destruction.” This is a phrase coined by Joseph Schumpterer in his work entitled Capitalism, Socialism and Democracy (1942) to denote a “process of industrial mutation that incessantly revolutionizes the economic structure from within, incessantly destroying the old one, incessantly creating a new one. It sounds akin to Adam Smith’s “invisible hand.”  From these notions we learn that we can’t always fully predict what might happen when we tinker with economic forces. If the free market is free, politicians must leave marketplace decisions to citizens and their free choices. The role of government is to level the playing field to the extent possible when allowing citizens to make free choices. But politicians and the government shouldn’t act surprised – or caught off-guard – when citizens make choices that are logical.

How could anyone not anticipate the doctor shortage becoming more acute, or insurance companies revising marginal policies for those already insured, when the Nation announces a policy that will add 40 to 50 million more citizens to the ranks of the plan-covered or insured? No one should have been blind-sided with this

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

1 comments | Topics: Affordable Care , Distributive Justice , Health Insurance , Medicaid


Athene Aberdeen

Athene Aberdeen wrote on 12/14/13 2:00 PM

It may be that the swing to alternative medicine will become more pronounced. They seem to be doing sound research and are not particulary tied to "Big Pharma". Getting insured for this service is something else, but then more and more people will be actively managing their health and ilnesses.

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