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Spirited Words

See below for a collection of reflections, writings, essays, poems, and other contributions that the ISH community has submitted over the years. We hope you enjoy.

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In the Future, Will Healthcare Be Reserved for the Rich?

By John Graham

November 3rd, 2014

Marc Lichtenfeld is an Investment Strategist and he is concerned that in the future healthcare will be available largely for the rich.  In his online blog he writes:  “When my mother had a medical issue a few months ago, she didn’t even bother calling her doctor. She just showed up. Luckily, the front office staff was competent, took one look at her and got her in to see the doctor right away. It paints a picture of a growing problem in the United States.”

Lichtenfeld goes on to say, “Regardless of what you think about President Obama’s Affordable Care Act, the very basic reasoning behind it is well-meaning – that everyone deserves healthcare. The implementation of the law itself is another story. But I think most of us do not want to see someone suffer needlessly, simply because they can’t afford to go to the doctor. However, Obamacare is not going to be able to prevent – in fact, it may even exacerbate – a significant problem going on in healthcare that will likely affect all of us. There is a dire shortage of doctors, especially primary care physicians. Sure, we may all have insurance now… but getting an appointment to actually use it is going to be extremely difficult in the future.

For some, it already is. There are two sides to the doctor shortage equation: supply and demand. With more than 32 million new insured people thanks to the Affordable Care Act and the 10,000 baby boomers turning 65 each day, the need for doctors is skyrocketing. While boomers live a healthier and more active lifestyle than their predecessors, we can ward off Father Time for only so long. Unfortunately, the older we get, the sicker we get and the more we consume healthcare. So demand for healthcare is going to go up. Way up. Supply is going in the other direction.

According to the Association of American Medical Colleges, America will face a shortage of 90,000 doctors by 2020 – half of the shortage will be primary care physicians. While there will be an expected 7% increase in the number of physicians, there will also be a 36% rise in the number of senior citizens. The National Association of Community Health Centers estimates that 62 million Americans will be without adequate access to primary care. If you’ve tried to book an appointment with your primary care physician lately, particularly if it’s not for something urgent, like a routine physical, I bet you have to wait weeks or even months to get an appointment. It’s only going to get worse. Of course, time is money. And putting off your health could cost you and your wallet a lot more down the road. Here are a few things to help ensure you can get the care you need when you need it.

  • Concierge medicine – This is where a patient essentially keeps a doctor on retainer, like you would a lawyer or consultant. The doctor is paid anywhere from $1,000 – $5,000 per year. As a result, the doctor is supposed to be able to see you when you need him. The retainer fees allow the physician to limit the number of patients, which helps assure there will be appointments available when it’s necessary.
  • Become a patient of a new doctor or the newest physician in the practice – Doctors who don’t have a huge number of patients will have more available appointments. Plus, if you start with the doctor when she is new, you’ll have plenty of time to build your relationship, which could be important down the road when you really need her.
  • Urgent care – Most people would prefer to see their own doctor, but when it’s not possible, urgent care clinics have become a much-needed resource. It’s a lot cheaper and more pleasant than the emergency room. And if you like one of the doctors, you can ask if they also treat patients in a practice.
  • See or talk to a nurse practitioner – For many routine things, like the flu or a sore throat, a nurse practitioner can diagnose the illness and, in some states, write a prescription. You’ll have a better chance of seeing the nurse practitioner instead of the doctor if it’s not something serious.
  • Don’t be a wallflower – With medical staffs overworked, it’s more important than ever to advocate for yourself or a family member. The squeaky wheel gets the grease and all that. Speak up and tell them what you want. If you can’t get an appointment, demand one (politely, of course). Tell them you’ll come in and wait for a cancellation. Ask if they have a quick call list of people to call in case of a cancellation.

I don’t recommend you routinely do what my mother did (she’d never done it before). You can pull this trick only so many times, but she was probably admitted to the hospital quicker than if she had walked into the emergency room and had to wait in line behind people who’d been shot or had axe handles sticking out of their heads. Unless you’re wealthy and want to pay a doctor a retainer, you’re going to have to figure out a way to work the system in order to get an appointment in the future. Either that or send your kid or grandkid to medical school.”

Not a very encouraging picture for the future of healthcare in the United States. Is Litchenfeld right? Time will tell but I think everyone realizes access to medical care is changing.  For some, access to healthcare may be better; for others, that may not be the case.  What do you think?  How are you planning for your healthcare future?  Important questions to ponder now.

John Graham, MD, President and CEO

Sara Moore