Opposition to health reform tends to come from those who are happy with the way things are and worried that change represents nothing more than the risk of losing what they already have. That’s precisely why the opposition rhetoric focused on “death panels” and “rationing” of care. Stories were told of how our health care system would become like the Canadian system where people die waiting in line for care. Such stories are vastly overblown, I assure you, having spoken with a fair number of Canadians who love their system and who, having come to the U.S. for one reason or another, are appalled at the convoluted way our system works.
But for those who fear that expanding health insurance coverage means long lines and wait-lists, Chapin White of the Center for Studying Health Systems Change has good news: Expanding coverage doesn’t necessarily mean that overall health care utilization increases. Instead, that depends on how much physicians are reimbursed. Pay doctors more and, it seems, we visit them more often (rather, they are willing to see us more often).
The Affordable Care Act expands coverage, but it doesn’t dramatically increase physician reimbursement rates. Ergo, we’re not likely to see large increases in physician utilization, and that means we won’t likely see a lot of rationing or wait-listing. Sadly, it means that many of the newly insured will have a hard time finding someone to care for them. Medicaid doesn’t pay doctors well. It never has. So, a lot of doctors don’t accept Medicaid patients. Giving low-income uninsured persons Medicaid coverage may shield them from high out-of-pocket expenses, but it doesn’t mean they will be able to go to any doctor they choose. So, the rationing that exists will be the rationing that largely remains from the stratified system we have had for decades, where those with private coverage get more than they need, while those with public coverage often fail to get enough. That is not new rationing. It is the status quo.