The Massachusetts model

Physician Kevin Pho:

Massachusetts is often held out as a model for national health reform, and the bills being considered in Washington emulate much of that state's 2006 landmark universal coverage law. As a physician in neighboring New Hampshire, I have had the opportunity to observe the effect of the Massachusetts reforms.

Today, 97 percent of Massachusetts residents have health insurance, the highest in the country. But less publicized are the unintended consequences that the influx of half a million newly insured patients has had on an unprepared primary care system.

The Massachusetts Medical Society reported that the average wait time for a new patient looking for a primary care doctor ranged from 36 to 50 days, with almost half of internal medicine physicians closing their doors entirely to new patients. And when you consider that Massachusetts already has the highest concentration of doctors nationwide, wait times will likely be worse in other, less physician-abundant parts of the country, should universal coverage be enacted federally.

When patients are forced to wait weeks to obtain medical care, they inevitably find their way into the emergency department for treatment that ordinarily can be handled in a doctor's office. Indeed, since health reform was passed, according to state data provided to the Boston Globe, Massachusetts emergency rooms have reported a 7 percent increase in volume, which markedly inflates costs when you consider that emergency room treatment can be up to 10 times more expensive than an office visit for the same ailment.

True health care reform should be focused on expanding the availability of health care, not health insurance. Indeed, insurance is part of the problem. Any proposed reforms that don't recognize this reality are doomed to failure.