Shortage of Doctors for ACA? Who would have thunk it?

[Savannahmann]

Actually, I did predict it. Several here did predict it. We were told that there was nothing to worry about. Everything would work out just fine, and there would be no nonsense stories about Doctor Shortages, and if there was, it wouldn't come back on us.

http://www.democraticunderground.com/?com=view_post&forum=1002&pid=4163058

Well surprise surprise surprise. It's beginning to happen just as predicted. First let's look at Sacramento. Covered California is a great success, held up as an example to the rest of the nation what can happen when a State works with the Government to get people covered under the ACA. http://sacramento.cbslocal.com/2014/02/19/another-cbs13-viewer-says-doctors-denying-covered-california-plan/

SACRAMENTO (CBS13) — Another CBS13 viewer says she’s being denied health care, because her insurance is through Covered California.

On Tuesday, we told you about a Sonora man with the same problem—unable to find a surgeon to provide a desperately needed operation on his back.

What the hell? In November, when I wanted people to start thinking about this problem, and working on some solutions, I was told by a few folks that I was spreading Fear Uncertainty and Doubt, I was even called a Libertarian. http://www.democraticunderground.com/10024063337

Well, it's just Sacramento. That is barely California you know, it's the State Capital, and things are going to be screwed up there. It wouldn't happen anywhere else. Like San Francisco as an example.

http://sanfrancisco.cbslocal.com/2014/02/19/covered-california-enrollees-complain-about-limited-doctor-choices-nearby/

When Turner called around to find someone else to treat her, she got more frustration. “The only doctors accepting new patients are urgent care clinics,” Turner told KPIX 5 ConsumerWatch.

Well we were told that one user here waited more than two years to get into see an OB/GYN, and that was long before the ACA. I asked what would happen when people had those shiny new insurance cards, and tried to make an appointment and found that the Doctors were not taking new patients.

I was told to stop spreading FUD. So instead of being ahead of the problem, I can look forward to our leaders in DC suddenly looking like deer in the headlights as they are run over with complaints like this that are local now and in another month or so will go National. It isn't a question of if, but when.

If we stay true to form, VP Biden will give a speech on this about the 10th of October, and our party will rush to pull something out of our ass on the next day.

Now, do we act surprised when this goes national? All doe eyed and astonished? Do we call on hearings in the Senate to find out why Doctors are booked solid and not taking patients? I bet we go all doe eyed and astonished and blame the Republicans. Fuck those people who can't get in to see a Doctor. They should live in St. Paul where there are plenty of Doctors who will see you.

http://www.democraticunderground.com/?com=view_post&forum=1002&pid=4163095

Apparently it's only a problem for smaller rural communities, like San Francisco, and Sacramento.

[Sancho]

1. Are you proposing that the ACA has revealed a real problem?

If we had universal health care, we'd need more MD's. The current stranglehold on the doctor pipeline is well known. ACA is going to uncover a LOT of problems that need fixing:

- the crazy prices for medical care and drugs
- the crazy profit of insurance companies and for profit hospitals
- the really poor quality of some health care in the US; variable at best
- the shortage of MD's (and also how some MD's are overpaid)
- the underestimated number of undocumented folks who will now show up in the system
- the use of personal medical data by big business for even more profit
- etc., etc., etc.....

That doesn't mean your prediction wasn't correct, but simply that the evidence will be showing up more and more as ACA is implemented.

[Travis_0004]

12. The problem is not necessarly lack of doctors.

Its low payment rates not attracting doctors.

I do accounting for a doctor, and if you certain types of insurance, he will accept you. A lot of the insurance on the exchange he will not accept, because the payments are too low (often below his costs.)

[Sancho]

13. Yep, and I'm in a family of doctors...

We need more doctors including ones who work for less...

[Ghost in the Machine]

27. Don't these Doctors understand that even if they are getting paid less, they are going to have a LOT

more business from people who are now insured and they will make MORE in the long run??

It's like the old saying: You can sell a man a $100 apple ONE TIME, or you can sell him a $1 apple a thousand times.... people need to learn to look at the LONG TERM benefits instead of this week's bottom line.

Peace,

Ghost

[Sancho]

28. Health care needs a culture change...

and I grew up in the 50's with an MD parent.

The majority of 20th century doctors were essentially primary care; even if they "specialized". Most hospitals were non-profit or public. This changed dramatically over the last few decades. Remember when it was considered unethical for a doctor to advertise?! I do.

Now, many MD's plan on being a wealthy specialist: radiology, neurology, oncology, etc. We have billboards everywhere advertising hospitals and doctors just like buying a dishwasher. Unfortunately, most of us don't have a Consumer Reports for medicine and little choice which ER someone ends up at after an accident.

The primary care doctors work for PA's and are locked into a specific hospital/insurance corporation. A single practice family doctor is almost impossible. Those doctors have to follow rules to maximize profits. It's nuts. Doctor's get paid to admit you to the hospital, push certain drugs, and run tests to help pay for those expensive imaging machines.

If we had a public option, non-profit hospitals, and better control of medical schools we could move to a system of dedication to the profession and taking care of people instead of medicine focused on $$'s. Our system encourages a bad attitude among the doctors, and it needs a major fix.

[Scuba]

29. "Most hospitals were non-profit or public. This changed dramatically over the last few decades."

This statement is demonstrably false.


http://www.aha.org/research/rc/stat-studies/fast-facts.shtml

[Sancho]

35. As I said...it's a changing dynamic that affects costs.

http://www.commonwealthfund.org/usr_doc/collins_convstudies_455.pdf

There's piles of research and opinions on this...one sample article.

[Sancho]

56. New report - notice profit vs non-profit for "trauma care"

http://www.tampabay.com/topics/specials/2014/trauma-fees.page

[Sgent]

42. True to an extent

but many specialties (in this case neurosurgery) have a line for months or even longer for elective surgery. Additionally, even given the lower reimbursement certain types of insurance cost more to accept -- more paperwork, greater chance of legal problems. Finally some providers actually do provide lower reimbursement than cost -- for instance, I can give 10,000 vaccines for $1, but if they cost me $2 then screw it.

[Sancho]

45. The system is fouled up...you shouldn't be paid and have to collect "per vaccine".

For most care, you should be paid to take care of a number of patients. I'm sure you know the arguments of pay for service. At least primary care should be changed to a single payer or public system.

It's probably inevitable, but it may take another generation.

[Ghost in the Machine]

54. What kind of neurosurgery is "elective"? Mine was an emergency case, which made the difference

between me walking or being a paraplegic... or possibly dying as a result of of my spinal cord ripping apart, causing me to stop breathing on my own.

As for your case of selling a $1 vaccine, but it costs you $2... we ALL know that's BS. ANY doctor who takes Medicare, or State funded Medicaid, like Tenn-Care, Peach Care(Ga) and all the rest always over-bill because they KNOW they are going to get paid a lower amount... an amount *they* agreed upon when they signed up to become Medicare/Medicaid Providers.

As an example, I was going to one "pain management" clinic where it was mandatory to get a "trigger point injection" or "epidural" before we got our prescriptions and could leave. The doctor would draw up a syringe with lidocaine, then proceed to give me a small shot in my back. Just a tiny little shot in the muscle to numb it, and it usually wore off before I got the 3 miles from the office to the interstate... but I digress. After the first shot, the doctor would ask if I needed a shot anywhere else. Sometimes I would ask for a second shot near the first one and also in my shoulder near my neck if it was hurting bad that day. If I didn't request any extra shots, the doctor would squirt the rest of the syringe into the garbage can and dispose of the needle in the used sharp box.

I started paying close attention to my Medicare invoices I got each month and noticed something very shocking and eye opening. They were charging me $175 for the ONE shot in my back, and on the days I got extra shots it was between $175 to $250 EACH... even though it came from the same needle, and the rest would have been wasted in the garbage can if I didn't use it. I had to go every two weeks, and they were charging Medicare almost, if not over, $1,000 per visit when I got the 3 shots. I never spent more than 30 minutes in the place, either. I was driving over 30 miles ONE WAY to get there, so it took me longer to drive there one way than it did to see the doctor, do my urine screen, get my shots, get my scripts and be on my way home!

They finally opened a pain clinic closer to my house, and I checked it out. When I asked for a trigger point injection, they took me into an x-ray room and used the x-ray to guide the needle. I asked them why they did that, because I had gone to the other place for over a year and they never once used any kind of x-ray equipment during epidurals and/or trigger point injections. The doctor looked at me in disbelief and said "well, you've never had an epidural or trigger point injection then!" A week later, I had an appointment with my neurosurgeon and told him about everything... and he said the same thing, then added "yeah, there's a word for that." I looked at him and said "fraud?" He didn't say anything, just nodded his head in agreement.

You and I both know you wouldn't be charging $1 for a $2 vaccine, you'd be charging $10, in hopes that the insurance company would pay you at least $4 - $5.

Peace,

Ghost

[Sgent]

55. Two thoughts

When I said "elective" I meant in a medical sense. Most neurosurgery are elective in that they can be scheduled over a course of weeks or months with no significant change in the long term prognosis. This compares to something like surgery to alleviate brain swelling, or from a severed spinal column which must be done immediately.

There are certainly cases where Medicaid (and even Medicare) reimburse less than the cost of a procedure. Off the top of my head I can think of a few examples. Although some of them are dated the idea holds.

One outpatient antibiotic was reimbursed $15 from Medicaid, cost the doctor (after significant shopping) $23, and was paid $40 by private insurance.

Two patients I know of require q6 week IViG infusions. The cost to the outpatient infusion center is $16,000. Medicare (not Medicaid) reimburses $15,950 and private insurance $18,000. This is a common issue with many chemotherapy drugs.

[quadrature]

40. the more doctors get paid, the less they work...nt

[dlwickham]

52. you hit the nail on the head

it's the same thing with medicaid and medicare patients

the doctors are losing money on these patients and we all know that healthcare in this country is big business

[Yo_Mama]

37. The problem right now is low reimbursements rather than a lack of doctors

Doctors are unwilling to accept a bunch of new patients whom it will cost them money to treat.

There usually have been doctor shortages in various rural areas, but not in most areas of CA. To prevent the problem with Medicaid access under ACA, Medicaid reimbursement rates were raised. But some ACA policies are trying to pay doctors quite significantly less than Medicaid/Medicare, so doctors just aren't taking a lot of these patients.

[Sancho]

44. I disagree about the number of doctors...

particularly with primary care doctors plus adding millions more people to the system.

I think if we had more doctors (including more on contract in a public system), the overall price would be much less.

[Yo_Mama]

47. Except that so far we haven't added millions of people to the system

As far as I can tell, we have added at most a million. Total enrollments in ACA policies are less than 4 million so far, and at least 5 million lost current policies.

The Medicaid signups seem actually doing better in terms of access than some of ACA signups in CA, but that is explained by the fact of higher reimbursements. Medicaid enrollments look high, but if you adjust for the normal Medicaid "roll", they don't yet seem to be that impressive either.

Now if we ever do get anything approaching universal health care, you will be absolutely right. There will be a real and very troublesome lack of primary care providers. There was a shortage in MA which got well over 90% coverage, and there will be in the US. But that's not the current problem. The current problem is the one we were warned about by consumer groups last year - narrow provider networks and low reimbursement schedules. Because of the shortage in MA, emergency room visits went up instead of down, so it is an important problem for which we need to plan.

I believe that the CA insurance regulators promised to work on the access issue and that they may be making progress, but of course we will have to wait and see.

[kelliekat44]

38. More opportunity for the non-priviliged to get into Med school and become MDs. more jobs.

Calm down..just saying. The current batch of MDs has not made us any healthier or why is sickness and disease and major medical problems going up? One of the problems is that the upper crust trained MDs are going into plastic surgery and other exotic areas to make fast money quick. They really aren't concerned about the actual health of people..just how to make money and fatten their stock portfolios...not about serving the greater good.

[Brickbat]

2. There are provisions within the ACA that fund expanded training for physicians, nurses,

nurse practitioners and other MAs to help with the new caseload. Revisiting primary care laws and regulations can help. The physician shortage was a thing before ACA; it's not just ACA that's causing the issue.

[Savannahmann]

5. I know.

My suggestion when I first raised this issue was for President Obama to propose a program to expand the training of Doctors. The ACA funds a little, but not much. By getting out ahead of the problem, we could have looked proactive, looking ahead and identifying problems, and proposing solutions to those problems.

Politics is sometimes the art of the possible, and sometimes it is the art of foresight. By pointing out problems that the future could hold, you at least look like you care about the citizens. Highlighting potential food shortages for example due to the California Drought. Start by identifying it as a potential problem, one that needs to be looked at. Explain how people who buy things, but don't use them, don't consume them, and just throw them away are harming everyone. There will only be shortages if we don't act together and act responsibly.

Later when the prices increase due to shortages, people will remember that you were out there first, pointing out the pothole miles ahead. Or you can act surprised like the idea that California grows a lot of food is completely new to you.

By ignoring the shortage of Doctors until it hits us over the heads, we don't look proactive. At best we look out of touch, of course Congress has plenty of Doctors to see to them. At worst, we look unconcerned and ill informed. That is not how you garner support from the voters. That is how you lose support and elections.

My point was, is, and will be exactly the same. We have some really smart people in our party. We need to think, and look ahead, and figure out what the problems are, and be addressing them before they show up. Even if our plan does nothing short term, we can talk about the steps we are taking to alleviate the problem long term, because sadly we lack the ability to wave a wand or a pen, and create doctors out of thin air.

It's a simple choice, proactive, or reactive. Proactive goes down in history books as someone who is forward thinking and planning ahead. The other usually becomes history a lot sooner.

[pnwmom]

3. (self-delete)

[pnwmom]

4. People were using this to argue against the ACA, but it would be just as much of a problem with

single payer.

There is already a primary care provider shortage. There are already doctors who refuse MEDICARE -- not just Medicaid.

The problem, which is well known, is that medical schools are producing too many specialists and not enough primary care docs. That is another issue Congress should be dealing with. They have made a start through the ACA, but it will take years to produce all the new doctors that we need.

So this isn't a problem specific to ACA -- though the ACA does contain some measures to help with it. Unfortunately, they will require time.

[Savannahmann]

7. My response above covers my opinion then and now

The biggest argument for getting out in front is the voters. We need them to vote for us. We can't have as a campaign platform that the Rethugs are worse. We need to be on the news identifying problems, and solutions to those problems. At at the very least announcing we are working on the problem with several people and we believe it can be fixed.

We can't win elections if we don't get people to vote for us. We can't tell them their ACA card is a big boon if they can't get in to see a Doctor. We have to be addressing the problem early, and positively. Or those voters will get it into their heads that Democrats are worse than Rethugs, and we've had enough of that.

[pnwmom]

8. I agree that we should keep advocating for measures that encourage doctors to go into primary care.

[Habibi]

11. Yes.

[Holly_Hobby]

6. When we looked into switching from our current insurance to the ACA,

the closest doctor to us who was willing to take it was 45 miles away. I live in a city of 650,000, I'd have to drive 45 miles north to an even bigger city to find a doctor. Screw that.

[jberryhill]

9. It's called "creating a market"

[aint_no_life_nowhere]

10. I've been my mother's caregiver for the last four years, taking her to every kind of doctor

and quite frequently. I haven't once been to a medical office building without seeing armies of pretty young ladies in short skirts and high heels pulling cases of drug samples behind them in carts. Nearly every time I'm in my mother's doctors' offices, there's one of these drug company reps either waiting to go in to speak to him/her or coming out of a meeting with him/her. I notice that the doctor usually spends more time speaking to these reps about the latest drug than seeing patients. I never saw this happening decades ago. Why does the doctor spend even one second of time with these drug company reps? They're not scientists. They're not doctors. The doctor should be getting his/her information about the effectiveness of the latest drug from a medical journal, not a sales or marketing person. I find this particularly frustrating because I've called doctor offices and been told they are overbooked and can't see my mother for weeks, even when she's in pain. When I read this article about the lady who couldn't get in to see an OB/GYN for two years, it pains me.

[Ikonoklast]

15. I knew a woman that was a pharmaceutical sales rep, before she "aged out" (her words).

The stories she told were, well, something else again.

[Mr.Bill]

18. The main function of those sales reps in doctor's offices

is not to educate the doctors about drugs. It's to push their brand over another by buying lunch for the office employees and placing samples in the office which will hopefully be given to patients and create customers.

I used to be one of these salespeople (we're not all pretty young girls ) I rarely got to talk to a doctor, I usually spoke to someone from the doctor's staff, and left literature behind to inform them about the product. Salesmen don't teach doctors about drugs.

[aint_no_life_nowhere]

21. Well, I can't count how many I saw with brochures speaking directly to the doctors

and taking up their time. I hear them from adjoining patient rooms while waiting my mother's turn for the precious few minutes a doctor will budget. As someone who has been to countless doctor office visits with my mother in the past several years, I would respectfully suggest that your own experience is not universal on the subject.

[Mr.Bill]

23. I spend plenty of time in doctor's offices.

And I have for years. My wife is on her second pacemaker, has had three heart surgeries, has asthma, and I could get carpal tunnel typing her medical history here. And as I stated before, I once made a living by visiting doctor's offices. Unless you spend every day there, you experience is anecdotal compared to mine, trust me. I can describe the magazines in most doctor's offices with a 50 mile radius of me.

[aint_no_life_nowhere]

24. Quite unconvincing

As mentioned, I have been accompanying my mother to doctor offices for appointments for years, usually several appointments per week. Alas, she's 94 and has a host of problems and has spent the last years in and out of hospitals. She also has a pacemaker. In addition, I myself have had a host of medical issues and have spent considerable time in doctor offices. I have been appalled to see how much time doctors devote to these reps. If my experience is anecdotal, unless you claim to have universal knowledge, yours is as well. Virtually each and every time I've been in a waiting room, I've seen the reps request a personal interview with a doctor, unless they already had an appointment. If they had no influence on a doctor's decision on what medications to use, the drug industry would not be spending millions on sending them to every possible doctor's office they can. Any time a doctor spends discussing new medications with these reps, and I'm positive you have engaged them in conversation in your work, is time that should have been devoted to patients.

[Mr.Bill]

25. It matters not to me what you are convinced of.

I merely presented a differing opinion to yours. We can agree to disagree, others can draw their own conclusions or present their own opinions.

[KoKo]

14. There are definitely problems with ACA rollout...and "collateral damage." But...

it's better we got it through than not. I just think the Roll Out should have been better anticipated (even with the Repug Disruption) and that they had focused more on the Human Aspects of rolling this out with lack of reliable internet access for many and lack of coordination early on to anticipate the disparity between those with internet online access and others who live in rural areas with no money to pay for that who needed "a person on phone line" to walk them through it."

The disruption from the poorly thought roll out is causing many problems which the RW can come in and use to their advantage... But, in the long run it's a huge step forward to Affordable Health Care for All.

But the Rollout and aftermath will be really hard to deal with ...given we have the Mid-Terms at the end of this year. (Edited for typing too fast and saying Next year)

Hopefully the worst glitches will be worked out ...before next November.

[Savannahmann]

16. Sorry my friend

Midterms are this November, as in just about eight and a half months from now.

Now you know why I was so adamant about getting in front of this. Because right now, it appears as though our national strategy is to run on the issue that the Rethugs suck. At least we're not them isn't much of a reason to get to the polls for the average voter.

[KoKo]

17. I'm aware that the Mid-Terms are this November...but the meme you speak of

is a winning stategy for Democrats for the past two Decades. "Republicans Suck and Disrupt everything that Democrats put forward."

That this has worked before doesn't mean it won't work again. After all No Wall Street Banker who was in charge of the Great Meltdown that caused this austerity on the "common people" has been held accountable.

So a Great PR Campaign by Democrats and focusing on Hating Repugs could cause a Win ...once again. (Even though many of us know better)

[Savannahmann]

20. I'm sorry

I misread the previous post. I apologize.

Some things just don't turn out as well as you would hope. I remember an ad campaign that went on forever. Pork, the other white meat. WTF? Seriously? That's all you could think of that would be considered positive about Pork? I remember license plates from Oklahoma that had the worst slogan ever. Oklahoma is OK. I can't believe it beat out Oklahoma doesn't really suck. Oklahoma, eventually you will reach the other side, we swear. Oklahoma, it's not that bad. Oklahoma is OK is a answer you come up with at a quarter till five on a Friday afternoon before a holiday weekend.

We aren't Republicans is the same damn thing. It's something you toss out there when you can't be bothered to do anything else, the long weekend is upon us and I've got reservations for someplace nice.

[KoKo]

22. I'm with you on this...just saying that Clever PR Campaigns have worked so far....

until they Don't. (If you get my drift)

[Seeking Serenity]

19. Local governments, schools etc. cutting staff hours to under 30 hours/wk

http://www.nytimes.com/2014/02/21/us/public-sector-cuts-part-time-shifts-to-duck-insurance-law.html

And this is in the New York Times, not the Washington Times.

I'm sorry but this is bad, bad, bad, and should have been absolutely predicted.

[greymattermom]

26. loan repayment for primary care

would go a long way. Folks go into specialties to cover their student loans. Also, India will send well trained physicians if we just increase the residency slots. The first place to start is to put dollars into primary care and medicine residencies. The Indians don't have big loans to repay.

[Scuba]

30. To blame the ACA for a shortage of physicians is ludicrous. ACA exposed the shortage ....

... it did not cause it.

[NCTraveler]

34. I personally hope that it does create a greater shortage of physicians.

These are good paying jobs. Many of the positions within a doctors staff are good paying jobs. As much of a critic as I have been about the ACA, this sounds very positive to me. We all want better paying jobs to be created. Now we have what could turn into solid paying jobs being created and it is a concern? I don't think we need to figure out how to spin this as the op suggests, I think we should shout it from the rooftops.

[Scuba]

36. Eggzaklee!

[Pretzel_Warrior]

49. Good points

[Savannahmann]

39. I didn't say it caused it.

I said it exaserbated the problem that already existed. Many of these points and posts were made months ago, when I was first trying to highlight the issue and get us thinking proactively.

The ACA will be blamed by many people, and we need to get in front of the problem or we will be associated with the problem. That is what I am saying.

[Scuba]

41. The ACA did not exacerbate the problem. We do not have more people needing care than before.

The number of Americans needing care has not grown. There was always a shortage of physicians. Before the ACA the shortage was driven by economics - many people needing care could not afford it.

Now that these same people have a way to pay, the shortage is exposed.

[gollygee]

31. I've had this problem with employment related insurance too

The only time I haven't had this is if I'm insured through a major local employer, as I am now. I recognize it as frustrating and agree that the administration needs to find a solution, but this is not a problem specifically about ACA.

[NCTraveler]

32. I have criticized many parts of the ACA...

but this seems like a positive to me. New doctors will be needed. New staff will be needed for those offices. You are telling me that we can't sell the creation of solid paying jobs? Many of the jobs this will create are above minimum wage. The way our current economy is set up, these needs will be met within a couple of years. Here we have what could be the creation of solid paying jobs and you are wondering how we are going to spin it? You are viewing it as a huge negative?

[Bandit]

33. And before ACA those same people had zero health care

More people have health care now than before and those that don't yet have any health care will before the next few years are done.

[Le Taz Hot]

43. I originally signed up through Covered California

for Blue Shield. After further research and finding out the list of doctors who actually accept patients, especially new patients, was very small, I cancelled it. I signed up for Kaiser (at least I know I can see a doctor) instead. It's the 60/40 plan with a $6,000 deductible per year per person so, basically, I can't actually USE it, but I was able to buy the best shitty insurance I could afford.

[Glitterati]

46. This has been addressed for YEARS

it simply takes TIME to get folks through medical school to affect a change. But, it IS being addressed.

My sister is in medical school right now - final semester of her fourth year.

Her entire education has been paid for under a government grant - with the only requirement being that she has to serve 2 years in an underserved area when she completes medical school, as a General Practioner. Full tuition, plus living expenses.

It's a government program and has been in place for many years. It's quite the incentive for 1) GPs and 2) folks like my sister who always planned to be a GP serving the underserved. That has been her life goal since high school.

[Pretzel_Warrior]

48. Anecdotal and hasn't been fact checked

So what we have is....this ACA is so crappy. No one will use it. Yeah, and you can't get an appointment because of increased demand.

Here's my data. My wife and I have actually had an easier time getting in to see our PCP since January. So that must be due to the ACA. Thanks, Obama! We even got our son in to see pediatrician on very short notice.

[Glitterati]

50. Same here

I had to change doctors because of several reasons, and the new one:
1. Got an appointment to see him within 2 days of calling. And, I live in an underserved area.
2. Is quite the card - a very funny, fun, caring human being in addition to being a Doctor.
3. Takes my new acquired ACA insurance plan (after being uninsured for 30 years thanks to a pre-existing condition)!

[upaloopa]

51. It is not Obamacare

It is insurance companies causing problems. This has been talked about for weeks on progressive radio.
Insurance cos are treating people who sign up on covered CA differently than those going straight to the carriers. They are making it hard to get information and not covering doctors in the locality of the customer amount other things.
The idea is to get people to blame the ACA just as you are doing.

[cbdo2007]

53. Just wait until they see what their payments are under a single payer system.

They'll be even lower.

This isn't really a big deal. It's a step in the right direction, so I fully support a "shortage of doctors" if it means the system as a whole is improving, which it is.