A non-partisan medical group called the Doctor Patient Medical Association made waves recently by releasing a survey that showed 83 percent of America’s doctors have considered abandoning their practices because of ObamaCare. Even some of ObamaCare’s staunch critics were surprised to find the number quite so high.
The survey can be fairly critiqued on a number of grounds, some of them endemic to all opinion surveys. The sample size consisted of 699 completed surveys, returned after over 16,000 faxes were sent out. The vast majority of respondents were from small practices, which stand to suffer the most under ObamaCare. In fact, one of the conclusions drawn from survey responses was that “Corporate medicine (including hospital and insurance companies) is intentionally trying to destroy private practice.”
For this reason, a certain degree of self-selecting negative bias would not be unexpected – in other words, the survey form was primarily completed by doctors who dislike ObamaCare. The DPMA seems to have taken reasonable precautions to keep the survey as broad-based and accurate as possible, but like all polls, it boils down to extrapolating the results of a relatively small sample to a large population.
Still, this is far from the first doctor survey to show that they generally disapprove of ObamaCare, or that a sizable number of them are thinking about leaving their practices. A December 2011 survey from the Deloitte Center for Health Solutions concluded most doctors “are pessimistic about the future of medicine as a result of health reform and think would-be physicians will consider other options,” believe ObamaCare will “hurt their incomes,” and expect “an increased demand for physician services by newly insured consumers and the exit of physicians to administrative roles in health plans, hospitals, and other settings are likely as a result of health reform.”
The Deloitte survey had a substantially higher percentage of responses from large hospitals and physician groups (about 27 percent, compared to 11 percent for the more recent DPMA study) but still found that “almost 7 out of 10 physicians believe the best and brightest who might have considered medicine as a career will think otherwise as a result of health reform.”
In addition to doctors quitting their practices altogether, there are concerns about reductions in hours worked, and reduced access to the doctors who remain in practice – due, for example, to increasing number of doctors who won’t accept Medicare and Medicaid.
Part of the problem with organizing support for truly effective, market-based health care reform is that the public has trouble analyzing medicine as a product, subject to all the rules of supply and demand. Fees for health care services and medicine are more akin to a “penalty” in the popular imagination – a bout of rotten luck that leads to financial pain, rather than an exciting purchase in which the best value for the lowest price is actively sought. Understandably, no one gets excited about buying medicine, the way they would get excited about buying a car.
But emotional attitudes toward a product do not suspend the laws of economics. Health care is a resource, produced and distributed by an industry. It can be paid for directly, or financed through a related industry, health insurance… which can, in turn, be purchased directly or provided by yet other industries, namely employers. The more complex this system becomes, the more difficult it is for price to settle at the best possible intersection of supply and demand. Money is a signal; third party payers are static.
Fewer doctors working fewer hours, during which they have less freedom to interact with their patients, means reduced supply. That will inevitably result in reduced quality, rationing, higher prices, or some combination of the three. No amount of coercive force, expressed through price controls, can erase that equation, and the history of price controls tells us that they usually make things worse. Whatever ObamaCare’s other failings, perhaps its worst sin over the coming years will be the way it reduces the supply of doctors… which is exactly the opposite of what America needed.