Even before the government shutdown, the Patient Protection and Affordable Care Act — nicknamed “Obamacare” by many — had entered the national spotlight. On Oct.1, we saw one of the first major effects of the Affordable Care Act, where conditions of the individual mandate supplemented the creation of an online health insurance marketplace — known as an exchange — to help millions of uninsured Americans buy coverage.
In principle, we fully support the Affordable Care Act and believe it will substantially upgrade the American health care system. But in practice, we worry the law does not fully address the needs and interests of health care providers, a shortcoming that could prevent it from being completely effective.
In particular, doctor apathy toward the exchanges could exacerbate already existing problems with the nation’s physician supply. A September survey from the Medical Group Management Association revealed that 40 percent of polled doctors were uncertain about whether they would join the government-sponsored exchanges, in addition to another 14 percent who said they would certainly not join.
These are troubling numbers. Because the ACA will grow the nation’s base of patients, the demand for health care will rise. Consequently, we worry the law could lead to a physician shortage — something that would be exacerbated if doctors have hesitated to join the exchanges. Given that the nation already faces a major shortage of physicians — and in particular, of primary care physicians — we worry about the consequences of a system that has not succeeded in attracting enough doctors.
Of course, the ACA is not to blame for the nation’s shortage of primary care doctors. Studies show that increasingly aging baby boomers, as well as general population growth, accounts for 85 percent of the increased need for physicians. In contrast, only 15 percent of the feared shortage would be explained by the ACA’s perceived harms on physician supply.
Considering that the individual mandate’s survival hinges on the participation of young, healthy adults to counteract the increasing health care costs of retired baby boomers, we at least cannot accuse or blame the ACA for ignoring the demographic shift. Still, without proper structural incentives put in place — whether they are established through the provisions of the ACA or through the general health care framework — we expect the number of aspiring doctors in primary care to proportionally decline.
Though we do not claim that doctors in general practice medicine because of the presupposed financial benefits, it is necessary that the government — when it opens again — make a large, substantial effort to ensure a ready supply of doctors when the ACA officially goes into effect next year.
The Affordable Care Act is magnificent in its ideals but imperfect in its implementation. We still applaud the president for advancing such a structural reform. But by considering the realities of not only the dynamics of American health care but also the demographic and consumption patterns of American people, we think that Obamacare could do a lot more to provide effective, meaningful health reform.
If the president’s main goal was to provide universal health insurance, then he has achieved it. But to provide a truly effective reform, the government must consider both the care provider and patient. In short, we shouldn’t necessarily celebrate the ACA for just its mere ideals of helping the disadvantaged, but instead when it proves to foster the continued growth of the entire health care system — including doctors.
Editorials are written by The Herald’s editorial page board: its editor, Rachel Occhiogrosso, and its members, Daniel Jeon, Hannah Loewentheil and Thomas Nath. Send comments to editorials@browndailyherald.com.
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