Costs Are Still an Issue

President Obama has said he would like to wrap up health care reform legislation by summer's end, but that may be tough as more questions arise over the cost of even a modest expansion of health insurance coverage. The Obama administration and other supporters of the various proposed initiatives have always presented reform as a two-goal effort -- to both expand access to the nearly 50 million Americans without health coverage and to reign in costs. But on July 16, Douglas Elmendorf, director of the Congressional Budget Office, reported that the various proposals being backed by Democrats not only would fail to clamp down on costs, but would probably increase federal health care spending.

"In the legislation that has been reported, we do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount," Douglas Elmendorf told the Senate Budget Committee. "On the contrary, the legislation significantly expands the federal responsibility for health care costs."

His comments were latched onto by Republican lawmakers, and even some Democrats, who say that expanding insurance coverage is, in principal, a good idea, but not at the expense of higher taxes and a mounting deficit, especially in a sagging economy. It has been estimated that Democratic plans to expand coverage would cost about $1 trillion over 10 years.

But the issue of a looming doctor shortage will have to be addressed, no matter what shape reform takes, experts say. Not only are some patients already having trouble finding a doctor in some parts of the country, but they are having to book far ahead. According to a recent survey by Merritt Hawkins, the average wait time to see a family doctor for a routine physical ranged from seven days in Miami to 63 days in Boston. In eight of 15 metropolitan areas surveyed by the company, it took at least 14 days to be seen by a family physician. The report noted that the long waits documented in the Boston area may be due to legislation in Massachusetts that expanded coverage for the uninsured.

"Long appointment wait times in Boston also may signal what could happen nationally in the event that access to health care is expanded through health care reform," according to the Merritt Hawkins report. "Increased demand [due to] improved access to care for approximately 47 million uninsured people can be expected to extend doctor appointment wait times in many markets."