The Hidden Crisis that the Healthcare Debate Ignores

By October 15, 2015Blog

There’s a broad consensus across the political spectrum that many aspects of the U.S. healthcare system fall short of the ideal; costs are too high, access too low, coverage too limited. The controversy surrounding healthcare reform stems from clashing philosophies on how to best solve these issues.  In the most recent wrinkle in the ongoing debate, former Florida governor and Republican presidential hopeful Jeb Bush released a detailed outline of his policy prescription for America’s healthcare woes.  The plan—touted as a viable alternative to President Obama’s signature Affordable Care Act—would replace the exchanges with tax credits and put a greater onus on the states instead of the federal government.

What’s interesting about Mr. Bush’s proposal, though, is not how it differs from Obamacare, but rather how it’s similar. Both systems seek to fix America’s healthcare system by addressing demand.  The key tenet of both the ACA and the “Bush Plan” is to make health insurance affordable to those who do not receive coverage through their employer; they hope to accomplish this with subsidies and tax credits.  But, of course, demand makes up only half of the pricing equation.  Supply considerations are equally important, and, in the case of healthcare, a key part of the problem.

The short explanation is that there aren’t enough doctors, and when demand outstrips supply, prices skyrocket.  This is still a concern for the U.S., and it will only get worse as more people receive coverage through the ACA (or the Bush Plan) and the population continues to grow.

So what’s causing this shortage?  It’s complicated, but it’s generally agreed that a dearth of residency programs is to blame.  And that’s where the politicians come in.  Funding for residency programs is allocated through Medicare, and Congress hasn’t increased that allocation since 1997.  (There’s currently a bill under consideration that will address the issue, and there were two similar bills proposed in the last Congress, though neither of those made it out of the House.)

If Congress was truly interested in bipartisan solutions, the residency shortage should be low hanging fruit.  Increasing the number of residency positions would simultaneously stabilize prices while increasing the creation of well-paying jobs.  What’s more, the costs would be relatively modest.  (What’s another $2 billion compared to $3.7 trillion?)

Instead, both parties continue to focus on the politically expedient (and divisive) angle of the cost to consumer.  The problem with this approach is that political expedience doesn’t usually translate into real world solutions; nothing will change as long as the debate is only about how best to subsidize insurance coverage.  Congress’  failure to address the residency crisis is like worrying about overcooking the roast while the house burns down.  

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