Supply side: the elephant in the room for Obamacare.

September 21, 10:25 PMPolitical Buzz ExaminerJames Hyde

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AP Photo/M. Spencer Green

Supply side: the elephant in the room for Obamacare. It’s pre-school economics: Supply and demand dictate whether or not prices go up or down. Under Obamacare, 30 million people would be added to insurance rolls in a market sector that has way too much demand, precious little supply and can’t increase prices to meet demand. Simply stated, there aren’t enough doctors and nurses to take up the Obamacare slack, public option or not.

In just about all market segments except medicine, when demand outstrips supply, prices rise. But, because insurance companies arbitrarily dictate what doctors get paid, they can’t adjust their prices upward, so it’s almost impossible for them to make all those years of educational sacrifice worth it. Obamacare added to the mix is bringing many doctors to critical mass. It will increase overhead but keep prices as they are. That makes the whole exercise untenable.

Obamacare added to the mix is bringing many doctors to critical mass.

Just how untenable comes from the most recent results of a doctors-only Rasmussen poll. Of physicians asked, fully 45% say they are ready to hang up their stethoscopes if Obamacare passes.

True, a bunch of these docs are threatening to toss their tongue depressors in a fit of pique with no real intent of doing so. Nonetheless, if even 10% goes, it’s the economy, stupid, and the law of supply and demand looms large.

Widespread Support?

In his “I Have a Plan” speech, Obama asserted rosily that there’s “widespread support” among doctors and nurses for his reform plan. The president must have got that peachy appraisal from the Proctology Czar he has tucked away in the bowels of the White House. Like other czars who don’t focus on their raison d’etre, this wizard spends his time trying to figure out how to enable bacteria to sue antibacterial soap companies.

Obama had best find an advisor who’s head isn’t deep in socialist sand, ’cuz he’s embarrassingly off the mark. The Rasmussen poll reveals that 65% of doctors polled oppose Obamacare. Widespread is a relative word, but “widespread” in the context of 35% support is a yawning chasm without a bridge.

And despite Obama’s nervy assertions that you can keep your doctor if you’re on the Obamacare insurance rolls, he’s wrong. If your doctor opts out of the plan, bye bye, doc. You’ll be shuttled to a nice, cheap Mafia doctor who patches up bank robbers on the sly.

While the Rasmussen poll doesn’t take nursing and other caregiver shortages into account, both are showing flat or sinking growth. Who wants to deal with a crotchety, double-diapered, 95-year-old with sewer breath when they could be running numbers through a spreadsheet making scads of money plus bonuses? Every nurse (my wife most of all) or caregiver with whom I’ve spoken about Obamacare has made a face like a newly weaned infant who’s been given his or her first dose of pureed broccoli.

Clearly, none of the verbose brainiacs who penned the current measures stopped to think about the supply side. They just assumed it would be there. It’s the typical myopic dwarfism of the liberal mindset: “Just do it. Focus only on building a new entitlement program to the exclusion of all else and we’ll wing it as we go.” So far, the track records of programs built using that process should bring a shudder to us all when we hear such claptrap. Let’s see, Social Security, broke—an IOU where the cash should be. Medicare, broke, if not completely, it will be by 2017 (if it even survives Obamacare). Medicaid is in the same boat. And we expect Obamacare to be a smashing success because…?

Assumptions made about the supply side have become a hardly surprising snag in the Obamacare rationale. Increasing supply is pivotal. Many MDs are going beyond med school to become specialists, sharply cutting the number of general practitioners (GPs), the doctors in the front lines of the Obamacare plan.

According to Physician Characteristics and Distribution in the U.S., a publication of the American Medical Association, there were 853,187 physicians in the United States in 2004. As of 2006 (the latest numbers from Googled sites), the Statistical Abstract of the United States tells us there were 800,500. That’s a significant drop, some of which is due to attrition when OB/GYN doctors chucked their duckbill speculums because malpractice premiums drove them out of the business.

In his book Catastrophe, Dick Morris tells us there are barely enough doctors to handle the current patient load, but nowhere near enough to accommodate 30 million new enrollees (Morris cites 47, but 17 million were cut when Obama realized they were illegal aliens. If he tries to cover them through some legislative sleight of hand, the Tea Party movement will go COFFEE [Cut Off Funding For Elusive Émigrés]).

Shortages of doctors and nurses are nothing new. They’ve been problematic for decades. There’s simply no way the current number of doctors, especially minus those who quit or opt out of the plan, plus the shrinking number of general practitioners, can possibly handle that much growth in demand.

According to the American Hospital Association , as of 2006, there were 2.7 doctors per 1,000 people in the U.S. But this figure doesn’t take acuity into account. Just how many of those 1,000 people are in need of continuing care and how ill are they?

Stir in population growth since then, and assuming a constant supply of doctors—a bad assumption, but stay with me—and voila, unavoidable care rationing, endless waits for treatment, and “Oh, sorry-it’s-too-late” access to specialists.

Voila, unavoidable care rationing, endless waits for treatment, and “Oh, sorry-it’s-too-late” access to specialists.

With a public option, those who buy into the government plan—which won’t be cheap, by the way; it ain’t free except for the indigent—will be fighting a dictatorial mandate when bureaucrats running the public option tell you what treatments you can get. That’s atrocious on its face. Only you and your doctor can make those decisions because each individual has unique needs that can’t be mined from a statistical database. So, anyway you look at it, it’s “Oh, Can-a-da, glor-ee-ous and free…” or “It’s teatime, your flatulence.”

If the public option/co-ops (whatever name they use to disguise government control of health care) passes, it’s going to get even dicier for doctors. It’ll be tougher to get more from a government bureaucrat bent on cost reductions. While surgery on a bum shoulder could generate a fee of $3,000, the insurers set the price tag at $1,750 (not real numbers, but close enough). Who makes up the difference?

In addition, insurance companies arrogantly and capriciously determine how much time a doctor can spend with an insured patient—between ten and fifteen minutes now—a rule that chafes at the soul of every doctor I know. Obamacare will cut that down to about 30 seconds if the public option gets passed, and overhead costs for doctors will increase. They’ll have to hire more nurses from an ever-shrinking labor pool, but not be able to increase fees to cover the costs.

Add that to the evil of ever-rising malpractice insurance (which, no doubt will rise because of the additions to the health insurance rolls), and you can see how more doctors will jump out of the insurance-based business model or the practice of medicine altogether. My doc was an architect before he made the move to earning his MD. Given his sputtering when I mention Obamacare, the old blue prints don’t look quite as bad as they did when he swapped his t-square for a scalpel.

What about tort reform? If you want to grow the supply side, it’s essential, but alas it’s a partisan casualty of the political patronage Obama promised to end (broken campaign promise number 77). The Democrats can’t tweak the noses of insatiably greedy trial lawyers because they comprise one of the party’s biggest donor groups.

Next, Obama says he wants to spur competition and claims his plan will do that. Bull scat. Why can’t we just buy insurance across state lines? That’s a competition driver on a silver platter, but, no, for reasons unknown and unexplained, it’s a non-starter. Obama voted against it during his short stint as a senator and clings still to flawed thinking about it.

In Vermont, we have about half a choice of insurance companies from which to choose and the rates are astronomical unless you opt for a million-dollar deductible. In others states there are as many as nine insurers. What’s the solution? Taking a page from Ronald Reagan’s speeches: “Mr. Obama, tear down the borders.” You’ll spur plenty of competition. Or would doing that become an impediment to getting your precious health care bill passed?

What’s needed most in these ridiculously partisan measures is some provision to make it easier for those who want to get into medicine to get the education they need with tuition assistance. Why not swap the $8 billion that was earmarked for ACORN and fund or guarantee medical school tuition as scholarships? That’s a far sounder investment than getting Mickey Mouse on the voter rolls and telling hookers how to set up shop tax-free. Eight billion dollars can get a lot of doctors on board.

Essentially, here’s where Obamacare all comes tumbling down: Cash-only or concierge practices together with doctors who opt to quit or retire early kicks critical support out from under the plan. Sure, everybody is insured, but where do they get care? It will cause the entire system to collapse under the weight of the patient load, and send people back to the ER, thus increasing unsustainable costs.

We do need health care reform. No doubt about it. But it shouldn’t come in the form of a Hail-Mary pass.

We do need health care reform. No doubt about it. But it shouldn’t come in the form of a Hail-Mary pass. A phased-in approach that includes incentives for more people to become doctors and nurses is the far better path to take.

The measures before us now simply won’t work unless the supply side is adequately bumped up. And if the guy in the end zone drops that Hail-Mary pass, trying to move reform forward again will take years, especially given the growing rancor Obamacare is generating. It’ll be just as it was with the Clintons. Stop, think, reassess and do it quickly in phases, not all at once at the speed of a greased pig on a well-oiled alpine slide. Do it right, not fast.