Jonathan Cohn

Health Care Hypocrisy Watch

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Republicans spend a lot of time attacking universal health care because, they say, it will mean longer waiting times to see pediatricians, family doctors, and other primary care phyisicians. They say it's already happened in Massachusetts, which since 2007 has given virtually every resident health insurance. And they say it will happen in the rest of the country, once the Affordable Care Act takes full effect.

It's a dubious argument: As I've noted repeatedly, people were waiting to see doctors in Massachusetts long before the insurance coverage expansions. The evidence that reform substantially increased waiting times is extremely weak. Most likely, the underlying problem there is the same one plaguing the rest of the country: A profound shortage of primary care providers. And it's a problem that's going to keep getting worse, thanks to an aging population, without major changes in the workforce.

The architects of the Affordable Care Act understood this. Not only did they boost pay for primary care physicians, bringing their potential incomes closer (although not close enough) to those of specialists. They also created a task force to recommend future changes that would bolster the primary care workforce even more. But the task force is stuck, Amy Goldstein reports in the Washington Post, because Republican are blocking its funding:

“We’ve been sort of hamstrung,” said Fitzhugh Mullan, a professor of medicine and health policy at George Washington University who is one of the 15 commission members appointed by the Government Accountability Office. The panel’s only activity so far, Mullan said, was a single conference call during which members were told they could not lobby members of Congress for funds or accept money to operate from foundations or anywhere else.

The National Health Care Workforce Commission is intended as an ongoing brain trust to focus new energy on solving an old problem that will become increasingly severe. The law says the new commission will analyze primary-care shortages and propose innovations for the government and medical schools--to help produce the doctors and other health workers the nation needs. The idea is to furnish expertise to counterbalance the intense lobbying of medical groups.

The commission is unlike many other aspects of the law, which have built-in money to carry them out. Despite the efforts of some Democratic senators, appropriations for the commission were not in the continuing budget resolution Congress belatedly adopted for the fiscal year that began last fall. President Obama has requested the $3 million in his budget proposal for next year, but Republicans who control the House oppose it.

It's almost as if the Republicans are more interested in political symbolism than they are in making sure people can see the doctor in a timely fashion.

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