Now that 40 million uninsured people will now have access to healthcare, where will they go to get

[Egalitariat]

it?

I've heard the argument that ERs will be freed up to focus on emergencies, because it will no longer be the primary care outlet for the uninsured, and that makes sense to me.

But every time I go to my primary care physician, it doesn't seem to me like there is a lot of spare capacity waiting on new demand to be created. Which is what the ACA will do.

I know this had to be contemplated and accounted for, but I haven't seen any meaningful analysis of the changing supply and demand dynamics that will come from the ACA.

[snooper2]

1. That's the arguement the right wingers here in Texas are making..

Oh noes, we don't have enough doctors for everybody!

From my experience doctors can use a little larger workload...

[Egalitariat]

3. That's where I've heard it as well. But it does seem like a reasonable question.

Is increasing doctor workloads one of the ACA solutions?

[HopeHoops]

8. I schedule appointments for the morning. The office is never full then. Afternoon - screw it.

[shanti]

23. that's the best time to go

when i was working, i'd plan my appointments for the late afternoon so that i could leave early and not have to return to work. now that i'm retire, all i see are children and the elderly at the morning appts.

[joeglow3]

13. You must know some lazy Doctors

The friends of mine that are Doctors work hours most anyone would complain about if they had to do it for a short period of time, let alone for 20+ years.

[CrispyQ]

18. Did you see Fareed Zakaria's health care reform special last night on CNN?

He is one of the few I can stand on that station!

I came in about 25 minutes into it, but what I saw was good. I hope to catch the whole thing again. He compare health care systems around the world. I believe it was in Taiwan where the doctors see a huge number of patients a day - way more than in the US!

The stats for the US were so bad on every level. In each segment the US took a beating! It was pathetic!

[TBMASE]

29. yeah but don't they have to limit their time with each patient

to accomodate more people? If you need 30 minutes but only get 5, is it really better?

[taught_me_patience]

30. You do understand that there is more work to do after your visit, right?

The doctor needs to imput all the shit you talked about into the computer, follow up on lab results, order prescriptions...etc. Figure it takes 10 minutes/patient for charting... if your doctor sees 20 patients in a day, thats and extra 3 hours of work to do. They end at 4:30 and chart for one hour to 5:30. That still leaves two hours of work at home. That's right... while you're pounding back a few cold ones and watching american Idol... your doctor is probably at their computer imputing your data. It sucks. Believe me, I'm married to a doctor.

[ChazII]

59. K&R your response

The one thing I loved about my former neurologist was that he took his time. Yes, waiting in the waiting room for 30 minutes of more was not uncommon, his patients did not mind. We even joked about it. However, we knew he would be giving us his full attention.

My father's urologist brings a laptop computer on wheels in with him for the exam. During the exam he inputs what is happening during this visit.

I look at it this way-- I don't want my child in a classroom with 30+ children, why would I want my dr to see an x amount of patients per day just on someone's say so.

Please tell your spouse thank you.

[LiberalLoner]

2. One of the things I'd like to see happen for our nation is

lots of nursing/urgent care stations. I remember seeing nursing stations in England when I visited decades ago and I thought they were such a good idea. Let's face it, sometimes we don't need a doctor really, sometimes we just need a nurse's advice.

[goclark]

17. I was in East Africa

in the '70's

I got a tooth ache that would not stop.

The hotel sent me to a Dentist near by.

He worked on my tooth in this tiny office.

I started to point to my tooth saying ..... "tooth hurts here."

He quickly informed me that he had been trained in England and he knew exactly how to treat me.

When he finished, I got worried because I had my Traveler's checks --
He quickly informed me that I didn't have to pay anything, " We have Socialized Medicine here. "

"Take these pills and you will feel better."

Didn't have to pay one dime.

Felt better immediately

[liberalhistorian]

38. Here in rural areas, physician's assistants,

most with doctorates, do much of the work, supervised by doctors via webcam, phone, etc. They can even presribe medication and perform basic operations in some cases (I had one remove an infected cyst). PA's are more than capable in most instances, and I"ve gotten great care from them. Perhaps that's something that will become more common?

[xmas74]

95. We have them in our ER for the acute care cases

and nurse practitioners are becoming more common in our doctors offices.

[MineralMan]

4. It depends where you are, I think.

In St. Paul, MN, I can get a same-day appointment at the clinic I go to. No problem. If I want to see a particular doctor, I might have to wait one day. That's the situation at all of the multi-specialty clinics around here. All of them welcome Medicare patients, too. In other areas, it may present greater difficulty.

[Fumesucker]

5. I wouldn't worry too much about that..

Quite a few of them won't be able to afford to use the subsidized insurance they have thanks to copays and deductibles so the problem won't be that bad..

[Hoyt]

28. Fortunately, many who can't afford copays, etc., will likely have Medicaid where there are no, or

small copays.

[Fumesucker]

34. And many won't..

Which was my point..

[SickOfTheOnePct]

6. No doubt in my mind that there will be at least a short term shortage of providers

And it will be exacerbated in some places as practices decide that they won't take all insurance, which means patients with those policies will have fewer practices to choose from.

However, as people become comfortable with the notion of seeing a PA or CNP rather than a doctor, it will ease up a bit.

[surrealAmerican]

44. I tend to agree, especially in regards to primary care.

I would add that practices not accepting some kinds of insurance is a problem we already have.


These are relatively minor problems, but we may need to provide some sort of incentives to attract more providers to the communities where they are most needed.

[JDPriestly]

7. A lot of the simpler work will be done by nurse practitioners.

At Kaiser, a nurse takes my blood pressure, etc. before I see the doctor. When I see my doctor, he has all the information he needs about me -- on the computer in front of him.

If I am seeing a specialist for something wrong with my hand or my foot, he looks at the computer and says, "I note that your doctor ordered you to have your blood pressure (or some other test) taken. You need to go to the nurses station and get that done." All my prescriptions, every medication I take is listed on the computer. Every allergy, everything. The doctors verifies my history but doesn't have to discuss everything with me each time.

Visits to the doctor are very efficient, very quick.

I still have to wait to see the doctor, but things are well organized. A nurse from a European country told me that, over there, nurses do a lot more than they do here. The doctors do a lot more supervising than they used to.

Doctors' time will be used differently than it has been used in the past.
More will get done with the same number of doctors.

[Fawke Em]

10. The ACA will also expedite putting our health records

(security) on electronic files that can travel with us. The nurse or PA checks the vitals and the doctor is freed up to simply look at the problem.

The problem, of course, is that fewer people want to be GPs since they're the lowest -paid on the doctor pole. This becomes important as more people have to pay back student loans and the loans on ANY medical school training are enormous.

We'll need to, as a country, look at education next and determine how to assist more people into emerging healthcare roles by reducing their student loan load.

[freshwest]

61. Yes, I was hoping that would be the next step. And infrastructure, of course.

[taught_me_patience]

25. Simple visits will be covered by a Physician's Assistant

that can see patients for colds and simple issues. The supervising doctor does have to sign off on the charts, though.

[xmas74]

96. CNP is very common in my area.

When I had a sinus infection, that's who I saw. With my edema (it was heat-related, something that had never happened before), that's who I saw. Same with my rash. When I had my kidney stone the initial exam was done by the CNP who then had her supervising doctor come in to assess.

I like using CNPs and when my child has been seen by PAs I've been happy with their care. I'd think that would be the best bridge for our future care-give the simpler cases to them and refer the others on to the supervising doctor.

[Hoyt]

35. Kaiser is the model we are heading toward. I've only been insured by them 7 months, but like it.

It's much more coordinated than the insurance I had before, where I could choose docs (who usually didn't communicate with each other) anywhere. That "choose anyone" insurance costs a lot more, but is what way too many folks want.

Unfortunately, a lot of people are going to think they are getting cheated by low quality care if they can't see any doc they want; can't get the exact care they want (even if something else is cheaper and better for them and the "system&quot ; don't get to sit in a nice waiting room with fancy paintings and big aquariums; have to sit next to what they think are the poor (I really get ticked at folks who think like that); etc.

Truth is, a lot of folks are going to have to make some acceptable sacrifices to make health care for all work -- providers, suppliers, insurers as long as they are in the game, and even us as patients.

[JDPriestly]

85. I saw a Kaiser specialist just this afternoon. He was wonderful. Really

dedicated. I never have the feeling with the Kaiser doctors that they are in it for the money or worried about the money.

They just focus on getting the right care for you. That is my experience. Of course, some people think that it is impersonal but I really like it. I have had two different primary care physicians, and I was happy with both of them. The specialists there have been great.

I am a patient at Kaiser. One of my family members used to work there but doesn't any more. I'm not spamming on this. It's just my experience.

[sinkingfeeling]

9. Everybody should read the law. Here it is and Title V is about

the healthcare workforce.

http://www.healthcare.gov/law/full/

The Act funds scholarships and loan repayment programs to increase the number of primary care physicians, nurses, physician assistants, mental health providers, and dentists in the areas of the country that need them most. With a comprehensive approach focusing on retention and enhanced educational opportunities, the Act combats the critical nursing shortage. And through new incentives and recruitment, the Act increases the supply of public health professionals so that the United States is prepared for health emergencies.

[Fawke Em]

11. Thanks...

Just answered my point above.

[Hoyt]

37. Good point. There is a lot of good stuff that seldom gets mentioned including incentives for better

integrated delivery systems; more primary care; community health centers; and more.

[pinto]

51. +1

Thanks for the link.

[Warren Stupidity]

67. yes but still there will be THOSE PEOPLE at the doctor's office now.

[djean111]

12. The AMA deliberately keeps the cost of being a doctor high,

and keeps the number of schools static, and requires the initial four year degree before one can even start medical training.
This needs to change.
IMO, etc.

[Sgent]

19. I'm sure they would love it

if they actually had anything to do with what you just listed -- they don't.

The biggest problem with expanding the number of medical school slots (or residency slots which could also be used to bring in foreign medical grads) is the fact that Medicare hasn't changed the number of subsidized slots for 15 years. The PPACA increased the number of slots, and there are 4 new medical schools already underway, with about 6 more worth of expansions to existing medical schools.

[liberalhistorian]

40. Sorry, but please explain why it's a bad thing

to require a B.A. before beginning medical school? Seems to me that that would be a no-brainer.

[soccer1]

69. Some 3 year med programs......

Med school on the fast track: A 3-year degree
Some schools offer an accelerated approach to a medical degree by adjusting curricula and training, a move that could boost primary care.

http://www.ama-assn.org/amednews/2012/05/07/prl20507.htm

[PatSeg]

14. I think we might see

more doctors being brought in from other countries through Medicare and Medicaid. There are government programs that American doctors want no part of, but foreign doctors will jump at the chance to practice medicine in the U.S. even it means a long term commitment.

[closeupready]

15. I personally think that would be so terrific.

Would be ecstatic if that happened - open up the practice of medicine to free market competition.

[PatSeg]

21. I had some lengthy

talks with a doctor from Bangladesh at the same time I was reading "Cutting for Stone" and the government here has a hard time attracting American doctors to work as interns or residents in government funded hospitals, often because they have huge tuition debt to pay off.

This is something that is already happening. Most of the doctors I've encountered in the hospital were from other countries and as a rule, they were some of the best doctors I've had.

[SickOfTheOnePct]

16. Yep

And I'm thinking that there will be a good number of doctors that won't accept some or all of the insurance plans on the exchanges.

[PatSeg]

22. True

Just like there are doctors now who won't take Medicaid or Medicare patients. It is going to take time to get this to work well.

Taiwan did an amazing job implementing universal health care and they did it in less than year, but it is going to be much more complex in the U.S.

[shanti]

26. at kaiser

foreign md's are 3/4 of the doctors there, from what i can see.

[Hoyt]

39. Not my experience, but as long as they are good and give a dang -- who cares.

[PatSeg]

42. Kaiser

actually is a good example of well run health care. There are things about it I don't care for, but they are motivated to provide preventative medicine which saves money and lives.

I was in a Kaiser hospital a few years ago and there were many foreign doctors. The care I received was extraordinary and the doctors were exceptional.

[raouldukelives]

20. It's why we can't sit back.

We have to keep pushing. It is a great victory but now the real work starts. Making sure everyone gets health care, not just insurance. It was the problem before the ACA and it remains the problem. Having insurance is by no means saying you will get heath care. I don't see that as changing, yet. The push must now become to make sure people get that care they desperately need. Damn the profits, full speed ahead.

[Warren Stupidity]

24. This concern is frequently used as a dogwhistle argument by the right.

The not so subtle implication is that white suburban idiots will be waiting in the doctor's office with "those people".

[Renew Deal]

27. There are people out there that don't want other people to have health coverage because it will

make it harder for them to get service. I think this is a twisted point of view.

[cbdo2007]

31. It's called supply and demand. Go ask a capitalist about it.

Long story short though....the more people need services, the more people will go into health care to get those jobs cause that's where the $$$ will be.

[pnwmom]

57. Not really. Med school has limited slots. But we can encourage the right balance

of internists and family practitioners vs. other specialists by forgiving some of the loans for people who go into primary care medicine. As it is, med school costs are so high that many doctors feel they have to go into a more lucrative specialty just to pay them back.

[cbdo2007]

62. Med school has supply and demand as well.

If there is a need, someone will come along and create a new medical school.

[TBF]

32. Maybe no more Friday golfing for the doctors ... nt

[Meiko]

33. You can't just dump

40 million new patients into the current health care system and not expect a problem. The politicians who wrote this legislation didn't take this into consideration, how could they? It would have taken a huge study over several months just to get a clear look at the problem. I see several doctors because I need to and not one of them has to little to do. My primary care physician is totally maxed out. If doctors begin seeing too many patients a day they make mistakes and the quality of care goes down. Some doctors may just retire rather than deal with increased costs of enlarging their staff and facility, could be thousands of them.

You also have to take into consideration the drain on support facilities. Labs, x-ray clinics and other testing facilities could easily be overrun. Instead of waiting a couple of days for a test you might find yourself waiting for several weeks.

What if the doctor just feels that he cannot ethically take on any more patients, what then? Is the government going to step in and force him? Is this the kind of health care we want. If the groups of people added to the system can't get an appointment because doctors offices are full, guess where they are going to go? how does this help anything. It just makes the current problem worse. What if the hospitals can't deal with the increased numbers and you can't get a hospital bed when you need one?

This is not going to be a seamless process. It is going to take time for the infrastructure to catch up with the patient load. Let's hope there aren't too many horror stories while this happens.

[closeupready]

47. Insurance paperwork is 40% of a doctor's time today.

Or at least, his/her staff.

We need to squeeze insurance company bureaucracies so as to get better return for our money spent, and there is SO MUCH FAT in those bureaucracies.

[Hoyt]

86. Even if some of that happens, it's better than people not having access to care.

I think system will adapt, although it may take patients accepting change too.

[hollysmom]

36. I think that is a false argument

It makes the assumption that not sick people will go whoohoo and fill doctors offices with their hypochondria.

It is far more likely that people will see doctors before they get seriously ill, maybe only slightly ill and that can be treated easier.

The people I know without money do not rush to get care from emergency rooms and they are not likely to change that behavior due to co-pays and what not. Those who work can't just take off time from work and tend to work through colds, etc. People who don't have a lot of transportation will not be traveling far.

In reality, I would not be surprised to see emedi centers opening wider with support staff to do a lot of the screening. I admit to going to emidicenters on Sundays when all doctors offices are closed and I don't want to go to the emergency room (lots of gun shot wounds at night). The staff is good, rushed a bit, but the staff takes your history and gives the doctor a good print out before they see you, they are very capable of doing that. They take your blood pressure, temperature, then there is nursing staff to draw blood, etc. The doctors have time to "doctor you, heh. I have had every thing done for a sprained wrist and only saw the doctor at the end. Was not a problem. It would be a good quick fix.

of cousre the answer is to increase training in this country and to provide scholarships for promising students.

[Hoyt]

87. I agree. I darn sure haven't run out and gotten a colonoscopy because they are covered 100%.

[Ohio Joe]

41. Assuming that is true... Won't that just create jobs?

Sounds like something repugs would hate... President Obama giving us health care and creating jobs at the same time.

[librechik]

45. exactly--many new jobs for construction of clinics (in ACA) and healthcare workers to staff them

that's another reason why they held it back--it's good for the economy!

[hughee99]

49. Creating jobs is great,

unfortunately, you can't just hire people to do some of this stuff and have them in the office next week. It takes time (in the case of doctors and nurses, years) to train them. In the meantime, you've already added new patients into the system, so there's bound to be some growing pains.

Of course, we could always start hiring doctors form other countries who are already trained, but there's a number of issues with that as well.

[Ohio Joe]

52. So we should not get health care because some people perceive there are not enough doctors?

Sounds like bad logic to me. I prefer the potential for doctors to be busy then no health care.

[hughee99]

53. I don't know where I said that, but I think telling people

the number of doctors (and nurses, and medical facilities) we currently have is just fine to cover the new people sets up an unrealistic expectation of how smoothly this will go. Better to acknowledge what our current shortcomings are now, as well as the plan to address them, rather than have the naysayers screaming "I told you so". In the short term, I believe they're going to be right about it. Rather than arguing with them just for the sake of arguing, we should focus on how we're going to resolve it, and explain why everyone will be better off when we do.

[Ohio Joe]

55. Already done by ACA

The ACA is set up to handle new training as linked above by sinkingfeeling in post #9:

http://www.healthcare.gov/law/full/

Complaining about people not being trained first makes no sense and comes across as a bullshit reason to shit on people getting health care.

[hughee99]

58. The ACA (which most people haven't read) has a plan,

but it will not have all the new staff and facilities it needs BEFORE people start getting health care. If you tell people the ACA is set up to handle this, people will expect that there won't be any problems FROM DAY ONE. There will be problems in the short term. People should expect some issues in the short term. If you tell them the ACA handles it, and they see problems, they're going to think they've been lied to unless you're very public about it up front (ie, "we expect to meet all our staffing and facilities goals by 20XX, until then, you may experience minor delays&quot . The right is screaming about this as if SOME people waiting a few extra days invalidates everything else the ACA accomplished (it doesn't), and some of the left seem to be saying that everything's fine and no one is going to have longer wait times, which I think is unrealistic as well.

[Ohio Joe]

60. And... Who said that?

"If you tell people the ACA is set up to handle this, people will expect that there won't be any problems FROM DAY ONE."

I've not seen anyone say that except those that are against people having health care. It is nothing more then a stupid teabagger argument against their own best interests.

[hughee99]

63. Who said that? I did, for one. So will many other people.

If you tell someone something is fixed, they will expect it fixed from day one. If they experience any problems, they'll think you fucked up. If you come back and tell them AFTER that you knew all along they were going to have these issues INITIALLY, and that your fix won't take effect for a period of time, they'll start to mistrust you. If they don't trust you, it will be harder to make changes later on when fixes or adjustments are required.

I see this every single day in a non-political environment. Keep in mind that a significant number of people in this country don't vote, don't pay attention, but soon, everyone will be involved with health care to one degree or another.

[Ohio Joe]

64. Well... You should stop telling people that if it is not true

No one I am aware of has said that 'Health care is now fixed'... I've just not seen anything that even insinuates that. You are creating arguments against people having health care... Why? A perfect system is not going to happen on day 1 no matter what happens, it has to start somewhere and this is a damn fine place to do so. If you have an issue with the things you have made up for yourself... Stop believing in them.

I'm sorry but... Creating reasons against people having health care based on things no one said, things that might not even be true and plain crap... Please, tell us what you think should be done?

[hughee99]

68. I'm not "creating reasons" for people to not have health care.

I'm saying that in the short term, the infrastructure isn't there to handle millions of new people RIGHT NOW. This isn't "creating reasons", or telling people something that's not true. It's telling people something that is true. There are shortages of doctors, nurses, labs, etc... that adding additional people onto health care rolls will make somewhat worse. Is there a plan to address this? Yes. Will will have to deal with delays in the coming few years while that plan is implemented? Yes, some people will. Is it worth it in the long run? Absolutely.

As far as "things no one said" there seem to be a number of people on this thread (and on others) that seem to think the infrastructure is just fine now, doctors just need to "work harder".

As far as "things I've made up for myself" you can say whatever you want to convince yourself that everyone is going to be understanding while the ACA goes through it's initial growing pains, but I know that's just something you've made up for yourself. You should stop believing it. It might not be true and may be just plain crap.

As far as what should be done...
Put it out now (or by the end of the year at least), what the goals are. How many doctors, nurses, lab techs, new facilities, etc... are expected, and by when. What plans are in place to resolve the issues that some people WILL experience, and at what time everything will be "fully up to speed". Saying "that information is in the ACA legislation" (and I don't believe it all is) is useless as many people, including those who voted for and against it, never read the fucking thing in the first place. This should be put out there, addressed in a major presidential speech, and pushed on the talking head shows.

[Ohio Joe]

71. "Is it worth it in the long run? Absolutely." Then... What is your problem?

[hughee99]

72. You're not really reading what I'm writing at all, are you.

It seems to me like my initial post wasn't as optimistic as you'd like and you've spend the last few posts trying to get me to say that everything's just fine (or just not say anything at all).

There's not going to be health care in the long run, if people get pissed in the next 3 or 4 years over the current system. Especially if they don't understand that what they're getting initially is NOT the long term goal. This can be repealed or at least gutted. "Selling" the American people on the promises of the ACA has not ended just because the legislation has passed. If Dems aren't proactive in addressing the plan, the short term issues, and the long term goals, then they may end up on defense all the way to the grave of this legislation. My problem is that if all the Dems have to say about the ACA now is "Your Welcome", the ACA will die a slow and painful death.

[Ohio Joe]

74. Non-sense, I've read every word... repeatedly. You are just not making sense.

Your complaint seems to be that the system is not perfect on day 1 so it will be a disaster. A look at google shows a number of articles playing up the jobs that will be created... I've seen zero officials stating everything is perfect... Yet, you predict doom unless it is perfect now. I'm just not buying that shit. No program has everything in place on day 1 and that may indeed cause some people to get upset... Will it cause them to say 'I was better off with out it, lets get rid of it'? No, that will be a repug talking point no one but repugs will buy into... But hey... Lets promote that on a D site... I'm certain that idea will work out well.

[hughee99]

75. I don't predict doom,

nor have I said, or attempted to imply, that if it's not perfect on day 1 it will be a disaster. I am saying that some people are under the impression that these issues are fixed, and that then when it's implemented, if people are not told what issues to expect initially, and how those issues are going to be addressed, they're going to think someone fucked up. Then, they'll get pissed. If enough people get pissed, there's going to be problems implementing those fixes (the repukes will see to that). It is, in my opinion, better for proponents of the ACA to be, very publicly, up front with the people about short term problems and long term fixes so when people encounter such problems, they feel confident that the people in charge anticipated this issue and are working to resolve it. I'm sorry if I don't think that's unreasonable, a repuke talking point, or predicting doom.

[Ohio Joe]

78. Yes, no doom

"if all the Dems have to say about the ACA now is "Your Welcome", the ACA will die a slow and painful death"

No doom at all, not anything the repugs will be trying to do, nope.

[hughee99]

80. Fair enough, let me rephrase that.

If all the Dems have to say about the ACA is "It's constitutional, bitches!" the ACA will die a slow and painful death. It's any easy problem to resolve, but they have to be proactive, and I haven't see much of that to this point. It would be predicting "doom" if I said there's nothing (or not much) they can do about it. The ACA decision is just an early battle in the war, not the final victory.

[Incitatus]

90. More educational grants for those entering the medical field and 0% interest loans

would help encourage more people to go that route. As a couple other posters have mentioned, nurses do a lot of the actual work. In many cases doctors just diagnose and give orders.

[frazzled]

43. The ACA contains provisions for training more primary care physicians

and for attracting more to practice PCP by paying them more.

On June 16, 2010, the Administration is announced a key step in that strategy – the availability of $250 million in new funding provided by the Affordable Care Act to expand the primary workforce. The new funding – part of the Prevention and Public Health Fund – will help prepare the health system to meet the demand for health care workers with a new initiative that will train and support thousands of new doctors, nurses, nurse practitioners, and physician’s assistants.

Combined with the earlier investments made by the American Recovery and Reinvestment Act, the provisions of the Affordable Care Act will support the training, development, and placement of more than 16,000 new primary care providers over the next five years.

More at: http://www.healthcare.gov/news/factsheets/2010/06/creating-jobs-and-increasing-primary-care-providers.html

Of course, this will take time; but it was not unforeseen in the legislation.

[kestrel91316]

46. Most the stuff I've seen a doctor for over the years could have been handled quite capably by a

nurse practitioner or physician assistant. There was that little matter of the shattered liver when the horse threw me in 1981, and the broken leg in 1968, and the major GI problem 1985-87. But other than that my life has been a medical cakewalk.

[TheKentuckian]

73. You gotta have those too. Quicker to ramp up than MD's but far from trivial

The ones we have are no less busy than the doctors and require a significant percentage of similar training.

I see no benefit of pretending it isn't a legitimate logistics issue, it isn't even a structural flaw that needs to be run away from or defended, it is just an expected part of the environment that is part of the deal that the law actually addressed, though it would be debatable if it resolved it and an important matter to get to the bottom of as quickly as possible because where the rubber mets the road will be all that matters to most people.

The law is passed, the Supreme Court has upheld it, the discussion is not to stop people from getting health care or even if this particular plan will move forward. Tinkerbelle does not require our applause, she will live or die in largest part based on her own viability which is dicey as hell but that is baked into the cake and can only be resolved by our ability to make substantial changes or supersede her with a whole other model before she comes apart at the seams.

[kestrel91316]

82. ACA includes substantial funds for increasing the pool of general practitioner physicians,

nurses, nurse practitioners and physician assistants.

[TheKentuckian]

91. I didn't indicate the issue was not addressed by the Wealthcare and Profit Protection Act

In fact, stated it was.

[hunter]

48. Patients will go to the doctor with problems that can be dealt with in ten minutes...

... instead of staying home until the condition worsens into something requiring many hours of a doctor's attention.

Without health insurance people put things off and then they show up in the ER in horrible shape.

An ounce of prevention is worth a pound of cure...

[spanone]

50. capitalism hates a void

[NNN0LHI]

54. My personal physicians office used to be standing room only and he was working 6 days a week

Now he is down to three days a week and most times I go in I am the only patient waiting to see him.

I would say he has some extra capacity for more patients.

Don

[madmom]

56. no more golf on Wednesdays?.....

[L0oniX]

65. 40? ...oh sure ...out of 330 million people ...sorry I don't believe that stat.

I am tired of the lies. There's a hell of a lot more people without any health insurance than just 40 million. WTF there's more than 50 million unemployed.

[Warren Stupidity]

66. It is around 50M.

Not everyone unemployed is uninsured.

[Egalitarian Thug]

70. A good start would be to declare the AMA a union and regulate it.

The AMA is the greatest single impediment to more doctors. This is done purposely and with the sole intent of keeping the supply down and the salaries up.

[Motown_Johnny]

76. The ACA also provides money for more clinics and for

schooling for people in the medical profession.


We already have over 250 million people in the system. another 40 isn't going to be that big a deal.

[d_r]

77. that kind of argument seems to me to say

"I would rather people die than get in front of me in line, that's what kind of selfish person I am."

This is the kind of thinking that will be the end of us as a species.

[cali]

79. CHCs. Bernie got 10 billion for them.

[quaker bill]

81. So our health system is good

only because 40 million people can't use it? On what terms could this be a desirable outcome?

[former9thward]

83. The 40 million have always had 'access' to healthcare.

They just could not afford it. And they still can't. The ACA does almost nothing realistically about cost. People like throwing numbers around but cost is the big unsolved problem. They will still crowd the ER.

[KG]

84. +infinity.

[Hoyt]

88. Many will be eligible for Medicaid -- no, or very low (like $2), copays.

[former9thward]

92. But the SC gave states the right to opt out of expanded Medicaid.

[Hoyt]

93. Most of them will take it. Why not, states are paying for it now and it's almost all federal money.

They'll run their mouths. If Obama wins, they'll quietly sign up for it.

[CleanLucre]

89. access to health insurance does not equal access to healthcare

[xmas74]

94. I would think that, in the short term, it could be a bit tougher to get into a doctor.

But an increased demand would make it more attractive for places to hire physicians assistants and nurse practitioners, turning over more of the preventative and acute care into their hands. The increase in hiring would make it a desirable field, making more interested in entering the field, which in turn would make more schools interested in offering the programs.

I really think more of our care will come from phys assist and nurse pracs and the more medically fragile cases will go to your MD. Personally, I prefer a nurse practitioner over most physicians.