By Br. Albert Duggan, O.P.
In the coming years, we will witness the gradual implementation of the Patient Protection and Affordable Care Act, the health care reform act signed into law by President Obama in 2010. This is one of the most sweeping changes to the U.S. health care landscape in decades—in many ways, larger in scope that the introduction of Medicare and Medicaid in the 1960s. It will put tremendous stress on a health care system that is already stretched very thin.
One of the most striking effects of the law will be that many more citizens will have health insurance: an estimated 32 million more people will have coverage by 2014. All things being equal, this is a positive change. Where previously, individuals who could not pay for medical care depended on charity care or visits to the emergency room, they will now have greater control and increased access to the help they need.
Nevertheless, there is a world of difference between having health insurance and obtaining high-quality medical care. Insurance is an important part of providing access to care, but only one step in a longer journey. An often overlooked question is whether the U.S. health care system has the capacity to care adequately for everyone who needs it.
Most health care facilities are already very crowded, and insurers have focused on shortening the amount of time patients remain hospitalized. For example, between 1993 and 2006, the average length of stay in the hospital for Medicare patients after heart failure decreased by over 25%, from almost 9 days to just over 6 days. Even if outcomes have remained consistent—and in many cases have even improved—patients often feel as though they are being rushed through the system. It will be important to attend to increasing the capacity of hospitals and other health care facilities to accommodate increased demand without compromising on the care patients receive.
The problem extends beyond physical space. Even more critical is the shortage of doctors and other health care personnel to provide care for an increased number of patients. Since the medical professions are highly skilled and specialized occupations, it will be important to plan well in advance for increased demand for services years down the road. Since, for example, it takes 7 to 9 years to train a doctor (depending on the area of specialization), it is important to be forward-thinking in the way medical professionals are trained.
We must consider not only the increased number of people with health insurance obtained through the Affordable Care Act, since many of these are relatively healthy young adults. In many ways, far more pressing is the growing proportion of older adults in the U.S. population, since health concerns often become more pressing later in life.
The American Association of Medical Colleges (AAMC), which oversees training for doctors throughout the country, has estimated that by 2020, there will be a shortage of over 90,000 doctors, nearly half of those being primary care physicians. We are already experiencing a significant shortage of doctors (particularly in rural areas and inner cities), and this will only become more widespread with time.
In order to address this demand for services, medical school enrollments are set to increase in order to train about 7,000 new doctors annually. Thus far, however, there has been no strategically planned adjustment in graduate medical education (residency programs), during which physicians and surgeons are trained in a chosen specialty.
Many residency programs are sponsored by funding from Medicare, but there has been no significant increase in financial support since 1997, while the number of older Americans insured by Medicare increases substantially. The AAMC has recommended that Congress lift the freeze on Medicare-supported residency positions to ensure that older adults continue to receive the health care that they need and deserve.
Opinions about the Affordable Care Act are certainly divided. As I discussed in last week’s column, the U.S. Conference of Catholic Bishops has voiced serious objections about provisions in the law which pose a threat to religious liberty and freedom of conscience. Even if these concerns are addressed, other practical problems associated with an expanding health care system and a changing population will require serious attention.
Mary, health of the sick, pray for us!
 H Bueno et al. “Trends in length of stay and short-term outcomes among Medicare patients hospitalized for heart failure, 1993-2006.” JAMA 2010;303(21):2141-7.
 American Association of Medical Colleges. “Physician Shortages to Worsen Without Increases in Residency Training.” https://www.aamc.org/download/286592/data/physicianshortage.pdf