Why Romneycare Is No 'Dead Hooker,' Even With The Latest Doctor Wait Times

I was watching Bill Maher interview Gov. Deval Patrick the other night, and one of his questions made me shout with laughter. Why oh why, he asked, does former Gov. Mitt Romney act as if being linked to the Massachusetts health reform he helped put into place is such a political liability it's like "being chained to a dead hooker?"

The "dead hooker issue" is particularly germane today for two reasons: Romney is scheduled to give a major speech today in Michigan about health care (See today's sage report by WBUR's Fred Thys on how the issue is playing in New Hampshire.) And the Massachusetts Medical Society has just put out its latest survey results on how long patients here must wait to see doctors. Opponents of Romneycare-style health reform are spinning the slight lengthening in wait times as further proof that the reform is bad here, and will be worse nationally.

But in The New Republic, senior editor Jonathan Cohn writes here in a piece titled "Defending Romneycare (because Romney won't do it)" that he sees quite a different spin.

...The report tells a far more complicated story, one that may not have much (if anything) to do with health care reform. And since Romney himself isn't making this case--I assume he just wishes the whole topic would go away--let me give it a shot.

While the long waits for physician services in Massachusetts seem real enough, the very same survey reveals that the long waits existed before Romney’s law took effect in January, 2007.

He shares some graphs of gastroenterology and internal medicine wait times, and says:

Reported wait times go up and down, year to year, which is precisely the sort of statistical noise you'd expect from a survey that relies on small samples size and the non-scientific testimony from physicians. Evidence of longer waiting times since the introduction of Romney's plan seems thin, at best.

Elsewhere, it appears that primary care physicians (although not specialists) are becoming less likely to see new patients. And that's certainly worrisome. But that decay was also underway before the Massachusetts reforms: It doesn't appear to have accelerated starting in 2007.

His bottom line:

...My strong hunch is that the real story in Massachusetts is an old one that's plagued the entire country for some time now: We don't have nearly enough primary care providers. As Nancy Turnbull, a longtime state official who now lectures at Harvard, told the Boston Globe after last year's ER report, “I don’t think the increase has anything to do with health care reform. It’s much more reflective of [primary care] access problems.’’

Solving that will likely require increasing the supply of pediatricians, family doctors, and geriatric physicians, as well as nurse practitioners and others who can handle primary care duties. The Affordable Care Act actually addresses that problem, by boosting primary care reimbursements. It may not be enough, but it would seem to be a step in the right direction--particularly since, whatever its modest effect on physician availability, it will provide financial protection to tens of millions of people.