Reducing the number of uninsured is a good thing, not a bad thing

For some time, we’ve recognized that we have a doctor shortage in the United States. While I’d add the nuance that we really have a primary care physician shortage, the end result is the same. People need to wait a long time to see their doctors. They feel like their physicians don’t spend enough time with them. And they feel like their doctors don’t know them well enough. They have a legitimate concern.

Fixing this problem isn’t easy. Training more physicians is expensive, and the numbers of residency slots are limited. We could increase the use of other practitioners, but many (including physician groups) often oppose such a plan.

This is a problem that will potentially be worsened by the Affordable Care Act. Many believe that as up to 30 million uninsured gain increased access, it will strain the system and make things worse. Recently, this argument has been used to oppose the Medicaid expansion:

Republicans on the House Energy and Commerce Committee sent letters to Medicaid directors in all 50 states and the District of Columbia on Monday seeking information about the program’s expansion under ObamaCare.

The letters, signed by committee Chairman Fred Upton (R-Mich.) and Reps. Joe Pitts (R-Pa.) and Tim Murphy (R-Pa.), says Medicaid recipients have experienced increased waiting times to see their doctors in recent years, and argue that those problems are likely to worsen under the Affordable Care Act.

“As scarce resources become even further divided, the most vulnerable Americans could face significant delay in accessing key services and treatments,” the letter reads in part.

It’s important to understand fully the implications of such an argument. Basically, they are making the point that giving more people Medicaid is problematic because it may make waiting times worse for those who already have insurance.

But this is an argument against ever reducing the numbers of uninsured. After all, expanding the numbers of uninsured through the most private, free-market solution ever would lead to the same issues. More people would have potential access to the same number of physicians, and wait times would be worse.

It’s telling, therefore, that no one ever seems to get upset at businesses that begin to offer insurance coverage. Those newly insured will strain the system as well.

Moreover, if adding people to the insurance rolls will worsen an already problematic system, then a natural conclusion would be that removing people from the insurance rolls would make it better. After all, if we increased the number of uninsured, then wait times for the rest of us would go down.

No one, of course, makes that suggestion. Making people uninsured to do this would be unthinkable for pretty much all Americans, regardless of their political bent. We recognize that making some people worse off to benefit the rest would be immoral in this situation.

But that’s really not that different than the argument that some make when they oppose the Medicaid expansion because of access issues. It’s completely reasonable to oppose the Affordable Care Act for a number of reasons. Opposing it because it reduces the number of uninsured is a difficult one to defend.


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