NCPA - National Center for Policy Analysis

Not Enough Doctors? Too Many? Why States, Not Washington, Must Solve the Problem

December 9, 2010

The states are far better equipped than the federal government to address increasingly complex and serious health care workforce issues.  But by enacting the Patient Protection and Affordable Care Act of 2010, Congress swells the costs and role of the federal government, while ignoring the critical role that states can -- and should -- play as a consequence of their existing oversight of key workforce areas, according to Roger E. Meyers, former dean and vice president of medical affairs at George Washington University.

The new health care law largely repeats the mistakes of the past: pursuing failed policies, while adding needlessly to federal spending, potentially deepening the budget deficit.  Congress is, once again, committing the states to unfunded and underfunded federal mandates.

Since 1981, projections of the health care workforce have been unreliable.

  • The federal government has attempted to solve physician problems (oversupply, undersupply and maldistribution of physicians by geography and specialty) through bureaucracy and changes in funding.
  • Despite consistent failures of the government's top-down approach, President Obama and Congress have pursued the same general policies through the Patient Protection and Affordable Care Act of 2010.
  • The states should determine the size and makeup of the health care workforce within their borders -- they are much better suited to address these issues than an expanded federal bureaucracy.

Meyer suggests:

  • Congress should convert existing and projected workforce programs into block-grant workforce funding to the states.
  • States should focus on primary care.
  • States should get serious about tort reform.

Source: Roger E. Meyer, M.D., "Not Enough Doctors?  Too Many?  Why States, Not Washington, Must Solve the Problem," Heritage Foundation, November 29, 2010.

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