Weiser can’t cut healthcare costs while Colorado is short 240 doctors

By Wayne Laugesen | Commentary, Wayne’s Word

Everyone running for office gives the same healthcare speech. Colorado Attorney General Phil Weiser, the Democratic nominee for governor who will certainly win in November,^[1] delivered a tidy version of it this week at a 9News town hall his Republican opponent skipped.^[2]

Healthcare costs too much. It’s too hard to get. Coloradans are squeezed, buried in medical debt, and stuck in a system that waits for them to get sick. 

He’s absolutely right. 

But Weiser’s answer laid out on the stump and in his Healthy Colorado Plan^[3] is “Primary Care for All,” a purchasing club built on the state employees’ health plan to force better prices, and a safety net stabilization push to get every eligible Coloradan enrolled in Medicaid. In a June interview,^[4] he said, “On the healthcare front, too many people are trying to make money off you when you’re sick.” The opposite is true. The cure, he said, is “primary care for all, the smartest, best form of care,” plus a crackdown on the “drivers of cost,” from Big Pharma to private-equity outfits buying up medical practices.

We’ve heard countless varieties of these redistribution schemes since the dawn of Obamacare, and healthcare prices have increased 129 percent in the 12 years since it took effect. In the 12 years prior to Obamacare and the Medicaid expansion, prices increased at a slower rate of 110 percent. Clearly, expanding coverage does not lower prices or increase access to care.

I expect better from my friend Weiser. (Hey, buddy, give me a call. We should talk). He has spent much of his career^[5] promoting competition and busting monopolies to keep consumer prices in check.

His primary opponent, U.S. Sen. Michael Bennet, D-Colorado, made the same old-school pitch from one step further left with a government-run public option for Coloradans who can’t afford marketplace coverage.^[6] Both men agree on the diagnosis. “Our healthcare system is broken,” Weiser says. 

He’s right that it’s broken. He’s wrong about the problem.

Look past Colorado and the speech doesn’t change. Abdul El-Sayed, the Democratic Socialist running for Senate in Michigan, wants Medicare for All, canceled medical debt, and more federal muscle on drug prices.^[7] Josh Turek in Iowa promises to take on Big Pharma and pharmacy benefit managers.^[8] (They must be shaking in their boots!) Sherrod Brown in Ohio is running against insurance-company denials and pricing.^[9]

The details shuffle. The offer doesn’t. Lower the price. Hand out more coverage. Tell people they have healthcare.

They don’t. They have a certificate.

“Handing out more Medicaid cards and calling them access is like printing half a million season tickets for Broncos games in a stadium with 76,000 seats.”

Healthcare is expensive and hard to get for one reason: There aren’t enough people to provide it. 

Providers of any service in short supply will charge what the market can bear. Price becomes the ration card. It sends the appointment to the patient willing and able to pay the most. Cut what Medicaid pays and you don’t cut the cost of care. You cut the number of doctors and clinics willing to take the card. The patient still needs a physician, but the physician has left the program.

Handing out more Medicaid cards and calling them access is like printing half a million season tickets for Broncos games in a stadium with 76,000 seats.^[10] Sure, you’ve got a ticket, but good luck finding a seat.

Washington already keeps score. More than 108 million Americans — nearly one in three — live in federally designated Health Professional Shortage Areas.^[11] As of June 30, the Health Resources and Services Administration said it would take 18,541 more primary-care physicians to erase those designations. Colorado alone is short 240, putting us in better shape than much of the country. 

It’s not an insurance problem. It’s an empty-chair problem.

Weiser’s plan nods at the workforce. “Stronger training programs” and ColoradoCorps,^[12] a service program for young adults, show up on his website, listed behind the big pillars on coverage and purchasing power. A corps is not a market. A few hundred more nurses and aides, however welcome, won’t change the math. Patients compete for a fixed number of doctors. Doctors don’t compete for patients — they essentially have a stranglehold on the market. 

Chicago School economist Milton Friedman offered a somewhat radical solution. “You would have better medical care, cheaper and more widely distributed, if you did not have the licensing of physicians,” he suggested. “The reason is very simple; it is because the licensure of physicians is the basic source of the monopoly power of the American Medical Association.”

That’s probably taking things a bit too far, but you get the point. The fix is a surplus. Flood the market until providers chase patients.

That means billionaire philanthropists endowing and expanding medical schools — the way Colorado’s the Anschutz family, headed businessman and entrepreneur Philip Anschutz, bankrolls the University of Colorado’s medical campus.^[13] It means more osteopathic medical schools, which already turn out an outsized share of the doctors who practice in rural and underserved places.^[14]

It means more four-year nursing degrees at community colleges, which Colorado has allowed since 2018.^[15] All states should copy this approach, rather than stopping at the associate degree and hoping a university finishes the job. Nurses with four-year degrees from community colleges make great candidates for medical school. Creating a surplus means residency slots to match the graduates, so a newly minted doctor isn’t stranded without a place to finish training. 

Do all of that long enough and price stops being a ration method. We could see serious results within a decade, whereas we’ve seen no progress after 12 years of the American Care Act (aka Obamacare).

We need too many sellers chasing too few buyers. That’s what gives healthcare a reason to compete with lower prices.

We can keep printing tickets. We can cap what the box office charges. We can sue the concession stand. None of it adds a seat. Until there health care providers have to earn their customers, every plan to lower the cost of care is nothing but a shell game.

READ THE FULL COMMENTARY AT WAYNE’S WORD

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