As Tom Petty taught us all in the 1980s, Waiting is the Hardest Part. That’s even more true when you’re waiting to see a doctor for a problem that needs attention. Anyone who has ever tried to secure a doctor’s appointment in this country knows that a) it’s going to be harder than scoring Taylor Swift tickets and b) you are going to face serious delays before you get your care. In this episode, we’re getting into the nitty gritty of wait times in the U.S. – how bad are they, how do we compare to the rest of the developed world, and why are wait times the right’s favorite scare tactic when it comes to Medicare for All?
The narrative attacking Medicare for All – you’ll NEVER get to see a doctor and everything will be like communist Russia… or, god forbid, CANADA! This is one of the top scare tactics used by opponents of Medicare for All, but their claims about wait times aren’t always based on the truth.
What our opponents seem to forget is that we have wait times in the US too. Ben, Gillian and our members all have stories about wait times, including Gillian’s story of being told “call back next year,” and Ben’s condition that worsened and turned permanent because he couldn’t get an appointment for for months for an urgent matter. We heard from members with horrific conditions that prevented them from working or even do normal day to day activities, but had to wait months or even over a year for care.
In our broken system, getting a wait time is actually a privilege; if you don’t have insurance or can’t afford the copay, you won’t even get to make that far-off appointment you need.
This is another reason we often end up in the emergency department. In some cases there is no other way to get medical attention for an urgent or emergent condition.
The reality of how our wait times compare to other countries’ is challenging to capture because the U.S. is one of the only developed countries that DOES NOT TRACK WAIT TIMES. Reporting is not required. In other countries, they track wait times for every service, and in some cases you can look up average wait times online for visits, procedures and hospitals. Research on countries with national healthcare plans shows that wait times vary dramatically, from country to country.
We often don’t even talk about the most critical wait times, which are ambulance response times and processing patients in emergency departments. It’s hard to find good comparative data on this, but these are major weaknesses of the U.S. healthcare system.
Finally, there is evidence of a major equity component here.
- Poor people and BIPOC have longer wait times for all services (including health services).
- Hispanic children have longer ED waits.
- Patients in poor neighborhoods have longer ambulance response times for cardiac arrest.
What actually drives wait-times? Unlike the scare tactics from the right, it’s not about the payment system. It’s mostly about adequate supply (of providers, specialists, scanning equipment, labs, etc) and accessibility – which is different from our payment/insurance systems. In general we do pretty well at wait times for very profitable services – like MRIs and CT scans. We do very poorly at unprofitable (or low-reimbursement services) like primary care, mental health care, and substance use care. There is an exception to this, because…
When it comes to wait times for particular physician specialties, including primary care, a major source of the problem is that physicians control how many medical school slots AND how many medical residency slots are available across the country, in every specialty. Economist Dean Baker calls this a “cartel.”
How would Medicare for All impact wait times in the U.S.? M4A might not directly impact wait times, but it would put into place tools that would allow us to control wait times. For starters, we could track wait time data.
Medicare for All would allow us to plan – by opening up more spots for medical residents in fields that are necessary, and by allowing for coordination of services and supplies. For example, we could coordinate the distribution of medical devices based on community need.
In the U.K., which also suffered from a primary care shortage, their National Health Service – as the single payer of providers – was able to raise General Practitioner (GP) pay in 2004, bringing their pay almost in line with hospital specialists. In first 3 years the number of GPs rose by 15%, and vacancy rates fell from 3.1% to 0.8%. Imagine what can be done with healthcare planning! Because there are hundreds of insurance companies who each pay different rates, there is no mechanism in the United State to recognize something like a provider shortage and respond to it with a pay increase or other incentive.
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